Infection Prevention and Control FInal Flashcards
What are standard (routine) practice?
Procedures applies consistently to all patients because there is no way of telling who is infectious and who is not, so assume all patients to be infectious
Who should use routine practices?
All health care workers to protect themselves, patients, and visitors
When should you use routine practices?
Whenever you expect to have contact with
- blood
- any body fluid including secretions and excretions (except sweat)
- mucous membranes
- non-intact skin
Fluids included in routine practice precautions?
- blood and blood products
- vaginal secretions
- breast milk
- semen
- saliva
- tears
- sputum
- vomitus
- feces
- spinal fluid
- synovial fluid
- pleural fluid
- peritoneal fluid
- pericardial fluid
- amniotic fluid
- nasal secretions
- urine
Fluids not included in routine practice?
-sweat/perspiration
Guidelines for routine practice include recommendations for?
- handwashing
- gloves
- mask and eye protection
- gowns
- patient care equipment
- environmental control
- linen
- occupational health and blood borne pathogens
- patient placement
PPE
- gloves
- gown
- mask
- eye protection
When do we wear gloves?
- touching blood/bodily fluids/secretions/excretions
- touching/cleaning contaminated items
- performing invasive procedures (phlebotomy, IV)
- performing test procedures
- handling patient specimens
- touching mucous membranes and non intact skin
When to remove gloves and wash
- after use
- before next patient
- when soiled or damages
- when touching non contaminates items and environmental surfaces (phones/keyboards)
What kind of gloves are used due to latex allergies?
Vinyl
What can contact dermatitis be caused by?
Allergy to latex, powder, chemicals, or other non relates causes
How to prevent contact dermatitis?
- take action before out of control
- barrier cream on hands
- cotton liners, gloves without powder
- different type of latex
- vinyl gloves
When to wear masks?
If danger of aerosols or splashes of infectious material
Types of masks?
- procedure
- surgical
- HEPA
- N95 respirator
- Airline (external air source)
Which masks are most common?
- surgical/procedure
- N95 (for airborne)
When to wear a gown?
- if danger of contamination with infected material
- to prevent transfer of microbes between patients
When to wear goggles?
-danger of splashes of infectious material on mucous membranes of eye/nose/mouth
***wear a gown if patient has MRSA
.
Donning PPE
- hand hygiene
- gown
- mask
- eye protection
- gloves
Doffing PPE
- gloves
- gown
- hand hygiene
- eye protection
- mask
- hand hygiene
When to wash hands?
- when hands contact blood or body fluids
- when hands contact contaminated equipment
- before and after removing gloves
- after a tear or suspected leak
- before leaving work area
- between patients
- after bathroom
- after blowing nose
- before eating and drinking
- at end of work shift
Soaps for handwashing?
- non-antibacterial: reduces surface tension (allows bacteria to be washed away), used for routine hand washing
- antibacterial: reduces surface tension and kills some microbes, critical care units, emergency/OR/delivery/medication rooms, where surgical and diagnostic testing performed, burn/dialysis/transplant units, after contact with patients with antibiotic resistant bacteria
Alcohol hand cleaner (ABHR)
- 70% ethanol/isopropyl best
1. Dispense about 5ml into palm
2. Rub finger nails, pour into other pals, rub nails
3. Rub finger/palms/back of hands
4. Air dry
How to prevent sharps injury when handling needles?
- activate safety device
- discard immediately after use
- do no recap
- use puncture resistant container, discard when 3/4 full
How to clean up sharp objects?
Uncontaminated broken glass: broom/dust pan/wet paper towel, broken glass discard
Contaminated broken glass: decontaminate 10 mins before cleaning up, biohazard broken glass discard
How to clean up blood/body fluids in patient care and client areas?
- can use incintinent pads/absorbent wipes/paper towels
- larger spills: wear PPE, contain spill then sweep or scoop and put in plastic lines biohazard container, decontaminate with disinfectant (1/100 fresh bleach) for 10 mins, clean up
- moderate spills: wear PPE, wipe with paper towel, put in biohazard container, decontaminate with disinfectant for 10 min, clean up
- small spills: gloves, if dried moisten first, wipe with disinfectant soaked paper towel or disinfectant wipe, put in biohazard container
How to clean up lab specimen spills?
- wear PPE, gloves as minimum
- decontaminate with disinfection (1/10 FRESH BLEACH), clean up with paper towel, put in biohazard container
- decontaminate surface with disinfectant for 10 mins
- clean up
Biohazard waste
- anything contaminated with blood or body fluids
- do not discard in regular garbage
- place in container with biohazard symbol
Laundry (linen)
- place in leak proof bags if wet
- handle carefully, regular laundry
Collecting and transporting lab specimens?
- wear PPE
- avoid contaminating collection container and requisition
- store in sealed container
What is a significant occupational exposure to blood and bodily fluids?
- skin in pierced by a contaminated needle or shard object
- blood or bodily fluid splashed onto mucous membrane
- blood or body fluid on non intact skin
- human bite
Protocol for a significant occupational exposure to bloods/body fluids?
- first aid as required
- allow (encourage bleeding)
- wash with soap/antiseptic and water
- bandage if necessary
- flush mucosal surfaces with lots of water
- report incident immediately to supervisor - occupational health - emergency department
Why do we have added precautions (transmission based isolation procedures)?
To minimize the spread of infection in the health care setting
- separate patients with transmissible infections
- protect immunocompromised patients
Who makes the decision about isolation?
-physician and infection control and prevention practitioners
What procedures must you follow if youre going to perform a procedure on an isolated patient?
- routine practice protocols
- and posted precautions (added precautions)
Types of rooms for isolation?
- Negative pressure: air flows into room from hallway, keeps microorganisms from leaving and spreading into hallways (TB), rooms have hepa filtration system to remove microorganisms from room air, keep door closed, TO PROTECT OTHERS
- Positive pressure: air is allowed to flow from the room into the hallway, protect immunosuppressed patients from outside microorganisms, TO PROTECT PATIENT
Protective environment (formerly reverse isolation)
- burn units, immunosuppressed patients, transplant patients
- usually includes: private room, hand washing especially before entering room, gloves, gown
- contaminated articles not brought into room
Disposal of items from an isolation foom
- have dedicated equipment for patient
- leave in room: thermometer, blood pressure cuff, blood collection, exercise and other therapeutic equipment
- equipment that must be removed is bagged for discard or bagged and transported to cleaning area before reuse
- serving food trays: gloves only, non disposable dishes bagged for transport to clean up area
Transporting patient out of isolation
- avoid if possible
- surgical mask on patient of airborne or droplet precaution
- if contact isolation: cover draining areas
- protect wheelchair with sheet
- receiving department must be notified
What is sterilization?
Destroys ALL FORMS of microbial life. Either sterile or not, no degree of sterility
What is disinfection?
Destroys pathogens, other microbes and spores may survive, several levels, usually chemical
What is terminal disinfection?
Disinfection procedure when patient leaves area, done before next patient arrives
What is an antiseptic?
Disinfection mild enough for living tissue
What is sanitation?
Disinfection of eating utensils and dishes, mechanical or chemical, agents used must not alter properties of food
What is cleaning?
Removal of soil/body secretions, does not imply disinfection, often soap and water
What is cidal?
Suffix means death, used to denote agents that kill various types of microbes
What is static?
Used to denote agents or procedures that stop microbial growth, but do not kill
What is SUD?
Single use device, item to be used only once then discarded
What needs to be sterile?
- anything contacting sterile tissue in the body
- containers to collect patient specimens for the microbio lab
- contaminated materials before disposal
Methods of sterilization?
- incineration
- autoclaving
- ethylene oxide (ETO)
What is incineration?
- terminal decontamination for biological waste
- burn at a very high temp, reduce everything to ash
- now usually done off site, health care facility must adhere to TDG regulations
What is autoclave?
- steam under pressure (moist heat)
- optimum temp: 121C, 15PSI, 15 mins once temp reached
- items on perforated tray, load loosely, dry goods on edge, canisters and tubes on sides
Testing the autoclave for efficiency?
- spore strips placed in autoclave (center and bottom)
- place strips in culture medium after autoclaving, incubate, check for growth
- growth means spores not killed, autoclave malfunctioning
Items suitable for autoclaving?
- surgical instruments
- dressings (before use)
- surgical gowns
- anything that has to be sterile and can withstand heat
- *not good for plastics or rubber
- items wrapped in paper or cloth
Ethylene oxide
- gas sterilization, no heat
- use for heat sensitive items (especially plastics)
- large capacity
- slow (8hrs), expensive, toxic to human tissue
Desirable properties of ideal disinfectant?
- broad spectrum
- rapid action
- resistance to inactivation by other materials
- nontoxic, odorless, nondestructive
- residual action
- user friendly
- economical
Spaulding classification of items requiring disinfection/sterilization?
- Critical: items going into sterile area of body, must be sterile
- Semi-critical: items going into or touching area of body that is not sterile, no pathogens, but don’t have to be sterile
- Non-critical: items not going into the body, but may touch body surface (beds, countertops), OK to have microbes, don’t want any that can be inhaled and cause infection
Resistance of microbes to disinfection?
- Vegetative bacteria : least resistant (easiest to destroy)
- Lipid Viruses (except Hep B)
- Fungi
- Nonlipid viruses
- Tubercle bacilli: difficult to destroy
- Bacterial spores: most resistant (most difficult)
Levels of disinfectants?
- Low level: kill vegetative bacteria and lipid viruses
- Intermediate level: kill everything except nonlipid viruses and bacterial spores
- High level: kill everything if sufficient time (still not sterile)
Groups of chemical disinfectants?
- Detergents and soaps
- Alcohols
- Chlorine-containing
- Iodine
- Phenolic
- Glutaraldehyde
- Peroxygens
Detergents and soap
Surface active agents (surfactants, wetting agents) reduce surface tension so liquid can spread out instead of bead up
-can be regular or antibacterial (regular doesnt kill microbes, but facilitate removal of them
Detergent vs. soap
Detergent: better at wetting agent
What are quats?
Quaternary ammonium compounds
- acts as detergent
- some antimicrobial action: attach to membrane, cause lysis
- low level
- cleaning, skin asepsis
- Zephiran
- economical, odorless, nonirritating, good wetting, kills G+
- narrow spectrum, inactivated by soaps, organic, G- rods may grow (Pseudomonas)
Alcohols (ethanol and isopropyl)
- intermediate level
- optimum concentration: 70%
- act by coagulating microbial protein
- skin asepsis, disinfect thermometers and tops of vials
- economical, nonirritating, kills vegetative bacteria, tubercle bacilli and lipid viruses
- not effective with large number of microbes, inactivated by organic material, does not kill spores and non lipid viruses
Chlorine-containing agents (bleach)
- hypochlorous acid kills microbes by oxidation
- intermediate level
- concentration expressed as: ppm chlorine, %hypochlorite, or dilution of household bleach
- economical, readily available, rapidly kills vegetative bacteria, longer time also kills tubercle bacilli and viruses
- no good for metal, plastic, rubber, odor, must be diluted fresh daily, irritating, inactivated by organic material, high concentration needed to kill spores
When would we use strong vs. weak bleach?
Strong: disinfect where contamination with biological material (organic material)
Weak: routine disinfection where no obvious contamination with biological materal
Iodine
- intermediate
- iodophor: iodine + carrier, carrier slowly releases iodine, less irritating, less allergic, doesn’t stain or sting as tincture (iodine + alcohol)
- pre surgical skin asepsis, cleaning compounds
- economical, kills microbes, good for cleaning when couples with detergent, some residual action
- must be diluted fresh daily (no hard water), staining, allergies, inactivated by organic material , not effective against HBV
Phenolic compounds
- intermediate level
- complex compound
- economical, odorless, non irritating, effective against microbes
- does not kill spores, toxic to some body tissues
Glutaraldehyde
- high level
- disinfection time: 10 mins
- sterilization time: 10 hrs
- cannot be used to sterilize critical items, too toxic to tissue, must rinse well with water = sterility lost
- disinfection of rubber, plastics, metal
- sterilization of equipment that can’t withstand heat
- broad spectrum, does not destroy rubber/plastic/metal, no inactivated by organic material
- expensive, limited shelf life after activation, toxic, irritating fumes
Peroxygens: combo of hydrogen peroxide and peracetic acid
- disinfect or sterilize, good for heat sensitive, complex items, can be used as a wipe for surface disinfection
- cost of equipment if using for sterilization
Types of mechanical disinfection?
- Pasteurization
- Filtration
- Microfiber cloths
Pasteurization
- 75-77C, 30mins
- intermediate level, kills everything but spores
- used for reusable tubing from respiratory equipment
- economical
Filtration
- filters with small pores to remove microbes from liquids and air
- membrane filters: removed microorganisms from fluids
- respiratory therapy equipment: keep patient bugs out of other parts of equipment
- HEPA filter: filters air, isolations rooms, drying cabinets, lab safety cabinets
Microfiber cloths
-used for environmental cleaning of surfaces
Methods of microbial control?
- UV radiation
- Ionizing radiation
- Moist heat (boiling)
UV radiation
- good at inactivating viruses
- good for destroying some bacteria
- reduces number of airborne microorganisms
- surfaces
- no good for spores
- must be a direct exposure
- water treatment
- avoid eye and skin exposure
Ionizing radiation
- includes irradiation, microwave, and strong visible light
- used to destroy microorganisms in blood products for transfusion, food
Moist heat (boiling)
- destroys some microorganisms within 10 mins
- no effective against spores- need prolonged time (6-8hrs) to destroy botulism spores
Reason for using aseptic technique?
To prevent sepsis (infection) in patient, keep sterile materials sterile, so do no introduce microorganisms in to patient
Federal OH&S
Outlines general rights and responsibilities of employer, supervisor, and worker
Provincial OHSA
Outlines provincial legislation
Occupational health and safety code
Details for the act
-healthcare associates legislation is found in part 35 of the code
Responsibility of the employer?
- provide safe workplace
- adhere to safety legislation
- provide equipment for safe work
- educate staff
- provide accident reporting mechanism
Responsibility of employee?
- adhere to safety regulation
- use safety equipment provided
- participate in safety education programs
- report accidents, unsafe conditions
3 levels of safety regulations
- Federal: WHMIS
- Provincial: WHMIS, waste disposal
- Municipal: fire, waste disposal
OHS of health care facility
- may not be onsite
- safety education
- accident reports
- safety inspections
- immunization
- work with workers compensation in case of staff injury
Accident reports
- employee must file
- report accident to supervisor and fill out accident report form no matter how minor the incident seems
- write out detailed account if no form
- do ASAP
- keep copies of everything in personal file
Personal safety
- Grooming
- Eye protection
- Food
- Medical sharps and safety engineered devices
- miscellaneous workplace safety guidelines
Grooming
- hair out of way
- clothing: unrestrictive, cleanable
- shoes: comfortable, closed toe, best if liquid resistant
- minimal jewelry
- nails: short, no colour or artificial nails
Eye protection
- prescription glasses, consider plastic side protectors
- goggles, face shields: supplies by employer
- check re: contact lenses
Food
- don’t eat, drink, or smoke in work area
- keep food in separate fridge form biological specimens
Medical sharps and safety engineered devices
- dispose of in puncture resistant containers-do not overfill
- activate needle guards before disposal
Misc. workplace safety guidelines
- keep pens/pencils out of mouth
- do not lick envelopes
- do not chew gum
- no smoking
- open doors carefully, keep right in halls
- clean up/report spills
Ergonomics
Promotes work environments that provides physical comfort, reduces stress and fatigue
Electrical safety
- know where circuit breakers are
- avoid extension cords with multiple adaptors
- used 3 pronged outlets (grounded)
- keep cords out of traffic
- unplug if smells hot
- ***if fire use CO2 or dry chemical fire extinguisher
3 classes of fires
A. Combustibles: use dry chemical or H20
B. Liquid fuels: use CO2 or dry chemical
C. Electrical: use dry chemical or CO2
PASS
- pull pin
- aim low
- squeeze handle
- sweep side to side
WHMIS
- federally and provincially legislates
- MSDS, labels, education
MSDS
- provided by manufacturer or supplier
- hazardous ingredients
- fire and explosion data
- reactivity data
- toxicology data
- preventative measures: PPE, what to do, disposal
- first aid procedures
- etc.
WHMIS label
- supplier label placed on by manufacturer
- workplace label if product put in different container, altered
- product name
- safe handling info
- statement that MSDS available
WHMIS education
Responsibility of employer
Radioactive material
- not covered by WHMIS
- regulated by canadian nuclear safety commission (federal)
TDGR
- covers safe handling in transit
- those who ship, transport, and receive dangerous goods
