infection prevention and control

Question 1

what is the prevalence and problem with HCAI?

Answer 1

costs the NHS round £900 million per annum
relative risk of death is 7.12
around £3000 extra per HCAI
estimated 5000 deaths per year from HCAI

Question 2

what is the chain of infection?

Answer 2

a pathogenic organism with sufficient virulence and numbers to cause illness, goes into a reservoir or source that allows it to survive and multiply. There is a mode of exit from the source and then transmission into the host. There must be a portal for entry into the host and then infects the susceptible, non immunised host

Question 3

what is infection prevention and control?

Answer 3

activities undertaken with the aim of breaking the chain of infection

Question 4

what are the steps in infection prevention and control?

Answer 4

eliminate the pathogenic organism, remove source or reservoir, minimise transmission, eliminate entry and exit and reduce susceptibility to infection

Question 5

how can we eliminate pathogenic organisms?

Answer 5

environmental cleaning and decontamination through H2O2 room decontamination, spillage management and laundry, equipment decontamination through disinfection and sterilisation, antisepsis and antibiotic prophylaxis

Question 6

what are two cases when antibiotic prophylaxis may be given?

Answer 6

post exposure and peri-operative

Question 7

what are two examples of antisepsis?

Answer 7

MRSA decolonisation and surgical skin prep

Question 8

how can the source or reservoir be removed?

Answer 8

through hand hygiene and environmental cleaning and decontamination

Question 9

how can transmission be minimised?

Answer 9

hand hygiene, PPE, equipment decontamination, single use disposable equipment, source and protective isolation, semmelweis

Question 10

what is included in PPE?

Answer 10

personal protective equipment:
aprons
gloves
masks

Question 11

what equipment should always be decontaminated?

Answer 11

surgical instruments, stethoscopes, blood pressure monitors, USS probes

Question 12

what is an example of single use disposable equiopment?

Answer 12

needles and syringes

Question 13

what is semmelweis?

Answer 13

using the antiseptic procedure

Question 14

when are the five times you wash hands?

Answer 14

before patient contact, before aseptic task, after bodily fluid exposure risk, after patient contact and after exposure and contact to patient surroundings

Question 15

what is the issue with hand hygiene?

Answer 15

they contain resistant bacteria that are deep seated and difficult to remove

Question 16

what is hand hygiene particularly useful against?

Answer 16

transient bacteria

Question 17

what are transient bacteria?

Answer 17

they are bacteria (also found on hands) that are easily picked up and transferred and easily removed. They are a major cause of HCAI due to this.

Question 18

what is the role of resident bacteria and when are they moved?

Answer 18

to protect us from colonisation of harmful bacteria - removed in aseptic procedures

Question 19

why are aseptic procedures performed?

Answer 19

to reduce the risk of contamination when inserting invasive devices or performing surgery

Question 20

when is soap and water used to clean hands?

Answer 20

when the hands are visibly soiled, for certain infections and contact with such as gastroenteritis and C difficile, and on entry and exit from any ward

Question 21

when is alcohol gel used?

Answer 21

when hands are not visibly dirty or when doing a non direct contact activity

Question 22

what is decontamination?

Answer 22

it is a combination of processes that removes or destroys contamination so that infectious agents or other contaminants cannot reach a susceptible sits in sufficient quantities to initiate infection or other harmful response

Question 23

how many decontamination methods are there?

Answer 23

there a many - which one to use depends on the individual situation

Question 24

what is sterilisation?

Answer 24

it is the complete killing or removal of all types of microorganisms

Question 25

when is sterilisation used?

Answer 25

on single use disposable equipment

Question 26

what methods are there for heat sterilisation?

Answer 26

moist, dry, autoclave, oven, specific pressure and temperature cycles (160 degrees for 2 hours and 170 for 1), delivery of steam under high pressure

Question 27

what other ways of sterilisation are there?

Answer 27

chemical, gas, moist, dry, liquid, filtration, ionising radiation

Question 28

what is disinfection?

Answer 28

it is the removal or destruction of sufficient numbers of potentially harmful microorganisms to make an item safe to use

Question 29

what is antisepsis?

Answer 29

it is disinfection of damaged skin or living tissue - requires a disinfectant with minimal toxicity

Question 30

what is almost always used in disinfection?

Answer 30

chemical products

Question 31

what properties of disinfectants are considered and why?

Answer 31

the effect on the microorganism (antimicrobial spectrum and sporicidality), chemical properties (shelf use, in use concentration, compatibility with other chemicals), physical properties such as corrosiveness and harmful effects - irritant potential and toxicity

Question 32

heat is the preferred option for sterilisation and for disinfection, when is chemical disinfection used?

Answer 32

in environmental decontamination, antisepsis and heat sensitive methods

Question 33

how is risk of infection classified?

Answer 33

high intermediate or low

Question 34

when do you a) sterilise, b) disinfect and c) clean?

Answer 34

a) items or devices that enter sterile body areas or break the skin and all reusable surgical instruments
b) items or devices that contact mucous membranes or are contaminated with bodily fluids
c) items or devices that only contact intact skin

Question 35

what must occur before sterilisation and disinfection?

Answer 35

thorough cleaning

Question 36

what is cleaning?

Answer 36

it is the removal of dirt, dust or any organic matter using water and detergent - it will remove around 80% of organisms if dried afterwards.

Question 37

what is cleaning suitable for?

Answer 37

any item that comes into contact with intact skin and prior to disinfection and sterilisation

Question 38

what is surgical instrument reprocessing?

Answer 38

it is the decontamination method for surgical equipment

Question 39

what comprises surgical instrument reprocessing?

Answer 39

the high risk of infection, the metal construction and paper cloth packaging for physical properties, resulting in a decontamination level of sterilisation and method of using moist heat

Question 40

how would a flexible endoscope be decontaminated?

Answer 40

the risk of infection is high, but it has metal and plastic construction, is not in contact with sterile area, and has fragile sensitive parts. Therefore the decontamination method is high level disinfection with chemicals or other alternative agents that are delivered via washer disinfector

Question 41

how is a syringe needle decontaminated?

Answer 41

it has a high risk of infection with plastic or metal construction and paper packaging. It is single use so sterilisation is used using y-irradiation pre use and disposal after use

Question 42

how would you decontaminate a central venous catheter insertion site?

Answer 42

it is living tissue and therefore you use disinfection - antisepsis. It is done chemically with 2% chlorhexidine and 70% isopropyl alcohol

Question 43

how would a surgeon decontaminate?

Answer 43

it is living tissue that is decontaminated with washing using surgical scrub