Infection Control and Personal Safety

Question 2

Any infection acquired by a patient while receiving treatment for a medical or surgical condition, includes nosocomial infections

Answer 2

Healthcare associated infection

Question 3

How much do HAIs cost each year?

Answer 3

24.8 billion yearly

Question 4

What were major sites of healthcare-associated infections in 2011?

Answer 4

1. Pneumonia
2. GI illness
3. UTI (#1 in 2002)
4. Primary bloodstream infections
5. Surgical site infections from any inpatient surgery

Question 5

What changed from 2011 to 2018 as far as healthcare associated infections?

Answer 5

• Pneumonia and surgical site infections stayed the most common
• GI infections joined them tied for first place

Question 6

How did hospital acquired infections change when COVID hit?

Answer 6

Higher rates of:
* Central line-associated bloodstream infections
* Catheter-associated urinary tract infections
* Ventilator-associated events
* MRSA

Increase in infection rates correlated with times of highest rates of COVID-19 admissions. Strong decline in C.diff infections

Question 7

What are risk factors for HAIs?

Answer 7

• Indwelling medical devices (IV catheters, ET intubation, urinary catheters)
• Skin breaks (surgical procedures, injection and venipuncture)
• Contamination of healthcare environment
• Transmission between patients and providers/staff
• Overuse or improper use of antibiotics

Question 8

What are outpatient risk factors for HAIs?

Answer 8

• Less oversight and infection control than hospital settings
• Improper sterilization and disinfection
• Reuse of syringes and needles
• Using single-use medication vials for multiple patients

Question 9

What are hospital “never” events?

Answer 9

• Objects left in patients after surgery
• Hospital-acquired urinary tract infections
• Hospital-acquired bloodstream infections
• Administration of incompatible blood products
• Air embolism
• Patient falls
• Pressure ulcers
• Certain surgical site infections

Question 10

What are direct methods of transmission through contact?

Answer 10

Hands, injection, ingestion

Question 11

What are indirect methods of transmission through contact?

Answer 11

Equipment/environment

Question 12

In addition to contact, what are other methods of transmission?

Answer 12

airborne droplets and droplet

Question 13

What are facility interventions to prevent hospital acquired infection?

Answer 13

• Written standardized policies with evidence-based protocol that is reassessed regularly, with needlestick protocol, and personnel competency and compliance with protocol
• At least one infection prevention person
• Proper sterilization of reusable and permanent equipment
• Job specific training for health care personnel and UTD immunizations
• PPE for adherence to standard precautions with fit-testing and handwashing supplies

Question 14

What are standard precautions?

Answer 14

Minimum infection protection standards for all patient care

Question 15

What does standard precautions include?

Answer 15

• Hand hygiene
• Use of PPE
• Safe injection practices
• Safe handling of potentially contaminated equipment or surfaces
• Respiratory hygiene/cough etiquette

Question 16

What is universal precautions?

Answer 16

• Older term
• Specific avoidance of body fluids due to infection risk

Question 17

What are key situations where hand hygiene is indicated?

Answer 17

• Before touching a patient
• Before exiting patient care area after touching patient or the patient’s immediate environment
• After contact with blood, body fluids/excretions, or wound dressings
• Peior to performing an aseptic task (ex placing IV, preparing an injection)
• If hands will be moving from a contaminated body site to a clean body site during patient care
• After glove removal

Question 18

When should soap and water be used for hand hygiene?

Answer 18

Visibly soiled hands or after caring for pts with known or suspected infectious diarrhea
Otherwise, alcohol based hand rub

Question 19

What are the most frequently missed areas of the hands while washing?

Answer 19

Thumb and tips of fingers

Question 20

What does PPE include?

Answer 20

• Gloves, gowns, face masks, respirators, goggles, face shields

Question 21

When should gloves be worn?

Answer 21

If possible contact with blood or body fluids, mucous membranes, non-intact skin or potentially infectious material

Question 22

When should gown be worn?

Answer 22

Procedures or activities where contact with blood or body fluids is anticipated

Question 23

When should mouth, nose, and eye protection be worn?

Answer 23

• During procedures that are likely to generate splashes or sprays of blood or other body fluids

Question 24

When should face shields/masks be worn?

Answer 24

To protect patients from oropharyngeal droplets from the provider

Question 25

What is the final step after removing and disposing of PPE?

Answer 25

Hand hygiene

Question 26

What is included in injection safety?

Answer 26

* Aseptic technique * Cleanse septum with 70% alcohol wipe * Don't reuse syringe for multiple pts, syringe to enter vial, single-dose vials/ampoules/bags, single-use administration sets * Dedicate multidose vials to a single patient if possible * Keep multi-patient multidose vials out of pt treatment areas * Approved sharp containers at point of use

Question 27

What are components of environmental cleaning?

Answer 27

* Follow policies and procedures for routine cleaning and disinfection of environmental surfaces and focus on surfaces in proximity to patient or frequently touched * EPA registered disinfectants or detergents/disinfectants meant for use in healthcare and follow manufacturer's recommendations for use

Question 28

What are critical items? How are they cleaned?

Answer 28

* Enter sterile tissue or vascular system * Must be sterile ## Footnote Ex: IV catheters, surgical tools

Question 29

What are semi-critical items? How are they cleaned?

Answer 29

* Tools that contact mucous membranes or non-intact skin * High-level disinfection prior to reuse ## Footnote Ex: coloscopes

Question 30

What are noncritical items? How are they cleaned?

Answer 30

* Contact with intact skin only; no mucous membranes * Low or intermediate-level disinfection

Question 31

What are environmental surfaces and how are they cleaned?

Answer 31

* Surfaces that do not contact pts * Routine cleaning, low level disinfection ## Footnote EX: floors, walls

Question 32

How should reusable equipment be cleaned?

Answer 32

* Clean and sterilize as appropriate * Cleaning, reprocessing, and maintenance following manufacturer's instructions * Staff need appropriate training and to access and wear appropriate PPE when handling and reprocessing contaminated equipment

Question 33

What are precautions for respiratory hygiene/cough etiquetts?

Answer 33

* Attempt to contain respiratory secretions in pts and visitors with s/s of respiratory infection from point of entry throuhgout visit * Signs at entrances for visitors with s/s to cover mouths/nose when coughing/sneezing, use and dispose of tissues, perform hand hygiene after hands contact repiratory secretions, provide tissues and no-touch receptacles for tissue disposal * Provide resources for performing hand hygiene * Offer masks to pts and visitors with s/s * Provide space and encourage symptomatic pts to away from others if possible, possibly in a separate waiting area

Question 34

When are contact precautions used?

Answer 34

* Infection spread by contact * Skin, mucous membranes, feces, vomit, urine, wound drainage, or other body fluids * Also if infection can spread via contact with equipment or environmental surfaces that may be contaminated by pt or secretions/excretions

Question 35

What are parts of contact precautions?

Answer 35

* Standard precautions * Gown and gloves upon room entry * Use disposable single-use or pt-dedicated equipment * For certain organisms with spores, consider use of a hypochlorite solution (ie bleach) for environmental cleaning

Question 36

When are droplet precautions used?

Answer 36

* Infection that can spread through close respiratory of mucous membrane contact with respiratory secretions

Question 37

What are droplet precautions?

Answer 37

* Standard precautions * Wear a mask upon entry of room * Possibly eye protection (maybe gown too?) * Single room preferred or at least 3+ feet and curtain between beds * If transported outside room, pt should wear mask and follow respiratory hygiene and cough etiquette

Question 38

When are airborne precautions used?

Answer 38

* Pts with infection that can spread over long distances when suspended in air * Small disease particles

Question 39

What are airborne precautions?

Answer 39

* Special respiratory protection and room ventilation * Standard precautions * Wear a mask or respirator prior to room entry, depending on disease-specific recommendations, most requiring N95 or higher (probably gown and gloves too) * Pts in airborne infection isolation room with special air handling and ventilation; if doesn't exist in facility --> private room with closed door until transfer * Non-immune workers should not care for pt with vaccine preventable airborne diseases