Infection Prevention and Control Flashcards
1
Q
What is IPAC?
A
- Infection prevention and control
- A set of policies and procedures designed to prevent transmission of organisms between EVERYONE entering a healthcare facility
- Led by department or individual
- ALL responsible who enter a healthcare facility
2
Q
Why is IPAC important?
A
- 1 in 9 people acquire an infection while in hospital in Canada (>220,000 people annually)
- 8,000 people die yearly from these infections
- Protects healthcare workers, patient and visitors from acquiring infections
- Following HAND HYGIENE can significantly reduce the spread of infection
- Following best practices for infection prevention can reduce the risk of some infections close to zero
- It can cost $25,000 to treat a single HAI
3
Q
What are HAIs?
A
- Healthcare Associated Infections
Examples: - Surgical site infections (SSI)
- Central line-associated blood stream infections (CLABSI)
- Ventilator-associated pneumonia (VAP)
- Catheter-associated urinary tract infection (CAUTI)
- Clostridium difficile-associated diarrhea
- Influenza/respiratory viruses
- Antibiotic resistant organisms (AROs - MSRA/VRE/CPE)
4
Q
The Chain of Transmission
A
- Infectious Agent
- Reservoir
- Portal of Entry
- Mode of Transmission
- Portal of Exit
- Susceptible Host
5
Q
Infectious Agents
A
- Need to have an infectious agent to start things off
- Bacteria
- Viruses
- Parasites
- Fungi
6
Q
Reservoirs
A
- Where the infectious agents hang out
- Humans
- Animals
- Environment
- Food
- On the body, high touch surfaces; bed rails, doorknobs, toilet flushes, equipment
- Number 1 source is humans in a healthcare environment
7
Q
Portals of Exit
A
- How the get out of the person
- Respiratory tract (coughing, sneezing, breathing)
- GI tract (vomiting, diarrhea)
- Non-intact skin
8
Q
Modes of Transmission
A
- Direct contact
- In-direct contact (common piece of equipment)
- Droplet (bigger and heavier; influenza, in contact for 2m)
- Airborne (a lot smaller and can travel much farther; TB, measles, chickenpox)
- Vector (mosquitos)
- Parenteral (needles)
- Vehicle (for example, often vials of insulin are shared among many patients)
9
Q
Portals of Entry
A
- How they exit a person
- Respiratory tract
- Mucous membranes (eyes, nose, ears, mouth)
- GI tract
- Non-intact skin
10
Q
Susceptible Hosts
A
- You face on onslaught everyday and are able to fight them off
- People are susceptible for many different reasons
- Age; medical devices; disease; medication; stress
11
Q
What link of the chain of transmission is being broken with IPAC?
A
Susceptible host; if you are being vaccinated it can get to you, but you can fight it off
12
Q
Routine Practices
A
- Prevent the transmission of microorganisms that cause infections in healthcare facilities from;
Patient to patient
Patient to healthcare worker
Healthcare worker to patient - Prevent contact with the body fluids of other people
- The level of care that should be provided for ALL patients at ALL times
13
Q
Components to effective hand hygiene
A
1) Kill and remove microorganisms on hands that you can’t see
2) Maintain good skin integrity
14
Q
When should you clean you hands?
A
- Personal
- Healthcare settings: “Your 4 moments for hand hygiene”
15
Q
“4 Moments for Hand Hygiene”
A
1) Before initial patient/patient environment contact
2) Before aseptic procedure
3) After body fluid exposure risk
4) After patient/patient environment contact
16
Q
Hand Hygiene Auditing
A
- Direct observation vs. Electronic monitoring
- Hawthrone effect; when people change their behaviour because they know they’re being watched
- Better hang hygiene correlated with decrease in transmission of microorganisms
- Barriers; placement of dispensers of alcohol-based hand rubs, issues with the product (hurts, want to clean with soap/water)
17
Q
How often should hands be cleaned?
A
- 5x/patient/hour
- 60 pumps/patient/12Hr shift
- 30 beds unit/1800 pumps/unit/12Hr shift
- Nurses have the most hand-on work; account for 65% of hang hygiene performance
- More opportunity in ICU; less opportunity during night shifts
18
Q
What is PPE
A
- Personal Protective Equipment
- Clothing or equipment used by healthcare workers for protection against hazards
- Used as part of routine practice when you are likely to be in contact with
Bodily fluids/blood/tissue
Non-intact skin
Mucous membranes
Contaminated equipment or surfaces
19
Q
PPE Risk Assessment
A
Key questions to ask during risk assessment:
- What task am I going to perform
- What is my risk of exposure
- How experienced am I in performing this task
- How cooperative will the patient be while I perform this task
20
Q
Principles for using PPE
A
- Assess risk of exposure and choose appropriate PPE to prevent contact with infectious material
- Make sure PPE fits
- Avoid contaminating yourself and the environment when using PPE
- Use “dirty to clean” concept when removing PPE
- The more you wear, the more you need to take off
21
Q
Patient Environment
A
- Cleaning and disinfecting
- Patient equipment
- Waste management
- Laundry
22
Q
Sterile
A
- Free from all microorganisms
- Not possible outside controlled environments
- i.e. controlled environment; operating room
23
Q
Aseptic
A
- Free from pathogenic organisms in sufficient numbers to cause infection
- Achievable in clinical and non-clinical settings
24
Q
Clean
A
- Free from marks or stains
- Not a satisfactory standard for invasive clinical procedures or maintenance of clinical devices
25
Q
ANTT Core Components
A
- Aseptic Non-Touch Technique
1) Identify and protect key parts and key sites - A ‘key part’ is the part of the equipment that must remain sterile (i.e. sterile syringe hub)
- A ‘key site’ is the area on the patient that must be protected from microorganisms (i.e. a wound or IV insertion site)
2) Ensure key parts only touch other key parts or key sites
3) Use: - Hand hygiene
- Non-touch technique
- A defined aseptic field
- Sterile equipment and/or clean existing key parts (i.e. scrub the hub)
4) Do not touch key parts/sites directly
5) Sequence your practice to ensure an efficient, logical, and safe order of tasks
26
Q
Additional Precautions
A
Required when:
- Patients are infected or colonized with a known infectious agent
- Have symptoms of an infectious disease
- Precautions taken are based on mode of transmission of infectious agent
- Used IN ADDITION TO routine practices
27
Q
Elements of Additional Precautions
A
- Routine practices
- Specialized accommodation and signage
- PPE
- Dedicated equipment and additional cleaning measures
- Limited transportation
- Communication
28
Q
Contact Precautions
A
- Wear gowns and gloves
- Almost any microorganism can be transmitted by hands
- We transmit regular bacteria as well but don’t do extra precautions because people have it
- Mostly for antibiotic resistant
29
Q
Droplet Precautions
A
- Influenzas, mumps, etc.
- Droplets usually enter through mucous membranes
- Face protection important
30
Q
Airborne Precautions
A
- Controlling the air
- Negative pressure room; air is constantly being pulled into the room as opposed to being pushed out; doors closed
- In operating room there is positive pressure
- N95 respiratory; seal check
31
Q
Initiating Additional Precautions
A
- Anyone can initiate additional precautions
- Initiate additional precautions for:
Unexplained nausea, vomiting, or diarrhea
Undiagnosed respiratory infection (influenza, TB?)
Undiagnosed rash (measles, varicella?)
Recent travel AND relevant symptoms
Hospitalization outside of Canada - Only IPAC professional can discontinue additional precautions
32
Q
Antibiotic-resistant Organisms (AROs)
A
- Microorganisms that have developed resistance to the antimicrobials normally used to kill them
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococci (VRE)
Extended-spectrum beta lactamase-producing organisms (ESBLs)
Carbapenemase-producing Enterobacteriaceae (CPA)
Candida auris - Spread by direct and indirect contact
33
Q
Clostridioides difficile
A
- Spore-forming bacterium that lives in the large intestine (colon)
- May cause symptoms when it becomes too prevalent in the colon
- Symptoms range from diarrhea to life-threatening inflammation of the colon
- Overgrowth may take place after antibiotic treatment that has killed the good bacteria that lives in the colon
34
Q
What to do with a patient with C. difficile
A
- Use contact precautions for patients with C. difficile
- Use dedicated equipment and cleaning supplies
- Increase frequency of room cleaning
35
Q
Colonization
A
- Having microorganisms on or in the body that can be transferred to others, but that cause no symptoms of illness
- Treatment is not required
36
Q
Infection
A
- Clinical signs of illness or inflammation that are due to tissue damage caused by invasion of microorganisms
- Treatment is required
37
Q
ARO Surveillance
A
- “High risk” patients are screened for AROs on admission to the hospital
- Swabs collected from body sites typically colonized by AROs (e.g. nose, rectum, groin, umbilicus)
- Point prevalence screening is the collection of specimens on all patients at a single point in tome to determine the total number of cases
38
Q
Emerging Pathogens
A
- Low(er) risk in Canada, but must maintain vigilance
- MERS-CoV, Ebola, Avian influenza (H5N1, H7N9)
- Ask about a patient’s travel history
- CPE
- Candida auris
- BEST DEFENCE = ROUTINE PRACTICES
39
Q
Ebola PPE
A
- CDC recommends full coverage of all skin and clothing
- Donning is putting on
- Doffing is taking off
- With ebola take time; always healthcare safety first, but don’t want to compromise patient; look at risks/benefits
40
Q
Carbapenemase-producing Enterobacteriaceae (CPE)
A
- Enterobacteriaceae lives in our bowels
- CPE produces an enzyme that can break down many antibiotics
- Spread by direct and indirect contact
- CPE infection case fatality rate is up to 50%
- Seriousness of CPE infection; we don’t have a lot of options to treat, important to prevent transmission
41
Q
Influenza
A
- Causes a systemic disease; not the “stomach flu” (norovirus)
- Seasonal influenza vaccine doesn’t protect for common cold and stomach flu
- Not just the flu for the young, old, immunocompromised, pregnant, and some other people
- By vaccinating yourself you protect the public
- All-cause mortality in long term care homes is reduced when all healthcare workers are immunized from the flu
- It takes your body 2 weeks to build protection after being vaccinated from the flu
42
Q
Healthcare Worker Influenza Vaccinations
A
- Influenza in vulnerable groups is associated with significant morbidity and mortality
- Vaccinating healthcare workers reduces the risk of influenza transmission to patients/residents/clients
- Infected individual can transmit influenza before they are symptomatic
- Unvaccinated individuals are often excluded from working on outbreak units
43
Q
Sink and Drain Contamination
A
- Hospital sinks and drains may be reservoirs for AROs
- Transmission of CPE to patients from drains has also been detected
- CPE sink contamination may result from:
Inappropriate use of hand-washing sinks for patient care activities
Rinsing body fluid contaminated receptacles in sinks
Disposal of body fluids in bathroom sinks
Inability to properly decontaminate plumbing
44
Q
Proper Hand Hygiene
A
- Protects patients and providers
- Reduces the spread of infections
- Reduces the costs associated with treating infections
- Reduces hospital lengths of stay, readmissions, and wait times
- Prevents deaths
45
Q
Incubation period
A
Interval between the entrance of pathogen to body and the appearance of first symptoms
46
Q
Prodomal Stage
A
Interval from the onset of nonspecific signs and symptoms to more specific symptoms
47
Q
Illness Stage
A
Interval when the patient manifests signs and symptoms specific to type of infection
48
Q
Convalescent Stage
A
Interval when the acute symptoms of infection disappear, and the body tries to replenish its resources and return to a state of homeostasis
49
Q
Exogenous HAI
A
– arises from microorganisms external to the individual that do not exist as normal flora; examples are Salmonella organisms and Clostridium tetani
50
Q
Endogenous HAI
A
– occur when some of the patient’s flora becomes altered and overgrowth results; examples are infections caused by enterococci, yeasts, and streptococci
51
Q
Where are the highest rates of HAIs
A
Older populations; increased susceptibility due to chronic disease and effects of aging process
52
Q
Medical Asepsis
A
- (clean technique) are procedures used to reduce and prevent the spread of microorganisms
- Example = hand hygiene, using clean gloves to prevent direct contact with blood or bodily fluids, and cleaning the environment routinely
53
Q
Surgical Asepsis
A
- procedures used to eliminate all microorganisms, including pathogens and spores, from an object/area
- Example = for objects that are required to break the patient’s skin or insertion into the body
IV, catheters, injections
54
Q
Principles of Surgical Asepsis
A
- All objects used in a sterile field must be sterile
- Sterile objects become unsterile when touched by unsterile objects
- Sterile items that are out of vision or below the waist level of the nurse are considered unsterile
- Sterile objects can become unsterile to airborne microorganisms
- Fluids flow in the direction of gravity
- Moisture that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by capillary action
- The edges of a sterile field are considered unsterile
- The skin is unsterile and cannot be sterilized
- Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis. They are what we call the “infection-control conscience”
