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NUR350 Midterm > Infection Prevention and Control > Flashcards

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
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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
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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)
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4
Q

The Chain of Transmission

A
  • Infectious Agent
  • Reservoir
  • Portal of Entry
  • Mode of Transmission
  • Portal of Exit
  • Susceptible Host
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5
Q

Infectious Agents

A
  • Need to have an infectious agent to start things off
  • Bacteria
  • Viruses
  • Parasites
  • Fungi
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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
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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
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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)
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9
Q

Portals of Entry

A
  • How they exit a person
  • Respiratory tract
  • Mucous membranes (eyes, nose, ears, mouth)
  • GI tract
  • Non-intact skin
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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
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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

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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
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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

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14
Q

When should you clean you hands?

A
  • Personal

- Healthcare settings: “Your 4 moments for hand hygiene”

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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

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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)
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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
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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
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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
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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
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21
Q

Patient Environment

A
  • Cleaning and disinfecting
  • Patient equipment
  • Waste management
  • Laundry
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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
  1. All objects used in a sterile field must be sterile
  2. Sterile objects become unsterile when touched by unsterile objects
  3. Sterile items that are out of vision or below the waist level of the nurse are considered unsterile
  4. Sterile objects can become unsterile to airborne microorganisms
  5. Fluids flow in the direction of gravity
  6. Moisture that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by capillary action
  7. The edges of a sterile field are considered unsterile
  8. The skin is unsterile and cannot be sterilized
  9. Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis. They are what we call the “infection-control conscience”

NUR350 Midterm (11 decks)

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