Infection prevention and control in paediatric office settings

Question 1

3 principles to prevent transmission

Answer 1

• assume all bodily fluids contain pathogens
• screen for sx
• source containment

Question 2

Give the precaution type and duration: MRSA

Answer 2

contact; if pts assessed at risk to transmit

Question 3

Give the precaution type and duration: bird flu

Answer 3

droplet + contact; 14 days from onset

Question 4

Give the precaution type and duration: enterovirual infection (supsected or diagnosed)…including HAND FOOT MOUTH

Answer 4

contact; for duration of illness

Question 5

Give the precaution type and duration: gasteroenteritis

Answer 5

contact; for duration or symptoms or until infectious cause ruled out

Question 6

Give the precaution type and duration: Hep A or E (diagnosed or suspected)

Answer 6

contact until viral infection ruled out OR if hep A diagnosed: 7days after onset of hepatitis

Question 7

Give the precaution type and duration: measles (diagnosed

Answer 7

airbrone; 4 days after onset of rash…if immunocompromised for whole duration of illness

Question 8

Give the precaution type and duration:

measles CONTACT who is non-immune and in the incubation period

Answer 8

airbone; 5 days after first day of exposure- 21 days after last day of exposure

Question 9

Give the precaution type and duration: meningitis (bact, vir) suspected or diagnosed

Answer 9

DROPLET until 24 hours after receiving antibx

CONTACT for whole illness

Question 10

Give the precaution type and duration: mumps

Answer 10

droplet; 9 days after onset of swelling

Question 11

Give the precaution type and duration: mumps contact who’s nonimmune and in incubation period

Answer 11

droplet: from 10 days after first day of exposure–> 26 days after last day of expsoure

Question 12

Give the precaution type and duration: pertussis (dx or supsected)

Answer 12

droplet until 5 days of appropraite antibx received or pertussis ruled out

Question 13

Give the precaution type and duration: petechial or ecchymotic rash with fever (suspected meningococcemia)

Answer 13

droplet until 24 h of antibx received or meningococcus ruled out

Question 14

Give the precaution type and duration: contact who is nonimmune and in incubation period

Answer 14

droplet; From 7 days after the first day of exposure to 21 days after last day of exposure

Question 15

Give the precaution type and duration: SARS MERS-CoV

Answer 15

droplet + contact + N95

To 10 days after resolution of fever

Question 16

Give the precaution type and duration: scabies

Answer 16

Contact Until initial therapy applied

Question 17

Give the precaution type and duration: skin infection with extensive lesions/abscess/drainage not covered or contained

Answer 17

contact; for duration of drainage or until exudative lesions are healed

Question 18

Give the precaution type and duration:GAS impetigo lesions not covered

Answer 18

contact; until 24 h of appropraite therpay

Question 19

Give the precaution type and duration:invasive GAS (pharyngitis, pneymonia, scarlet fever)

Answer 19

droplet until 24 hours antibx

Question 20

Give the precaution type and duration: TB (dx or suspected)

Answer 20

airbone until assessed as non infectoius

Question 21

Give the precaution type and duration: varicella

Answer 21

airbone plus contact until lesoisn crusted and dried or varicella is ruled out

Question 22

Give the precaution type and duration:varicella contact who is nonimmune and incubation pateint

Answer 22

airbone; from 8 days until fisrt day of expos–> 21 days after last day of exposure….to 28 days if given VZIG

Question 23

Give the precaution type and duration:viral resp tract infection

Answer 23

drop + contact for duartion or illness or until viral inection ruled out

Question 24

Give the precaution type and duration: zoster not covered

Answer 24

airbone plus contact until lesiosn crusted adn dried or zoster ruled out

Question 25

contact precautions: how?

Answer 25

gloves, gowns, distinfection of surfaces...most common

Question 26

give 3 egs of dx's needed droplet precuations (surgical mask)

Answer 26

H flu N meningitidis B pertussis

Question 27

Give 3 egs of dx's needing droplet + contact precautions

Answer 27

``` TSV influenza parainfluenza rhinovirus adenovirus SARS coronarvirus ```

Question 28

3 egs of dx's requiring airborne precuations

Answer 28

varicella, measles, TB, smallpox

Question 29

which dx's can go from contact-> airbone precautions with bronchoscopy, intubation

Answer 29

SARS coronavirus MERS avian flu viral hemorrahgic fever

Question 30

medical equipment: explain cirtical vs semicritical vs nonccritial

Answer 30

crtiical : must be sterile because --> sterile body space (eg: needle); semicritical: requires high level infection to remove everything except bacterial sports (touches mucous membranes or nonintact skin or thorugh whihc isnpired air flows, eg: laryngoscope; noncritical: low-level disinfection b/c only in contact with intact skin (eg stethoscope)

Question 31

ways to sterilize equipment?

Answer 31

Steam, dry heat, chemical sterilants

Question 32

ways for high-level disinfection?

Answer 32

Pasteurization, 2% glutaraldehyde, 0.55% ortho-phthalaldehyde, 6% to 7.5% hydrogen peroxide with or without peracetic acid*

Question 33

ways to intermediate-level disinfect?

Answer 33

70% to 90% ethyl or isopropyl alcohol (immersion >5 min), sodium hypochlorite 5.25% diluted 1:50 to 1:500 (immersion >10 min), 3% hydrogen peroxide, 0.5% accelerated hydrogen peroxide, quaternary ammonium products, iodine, iodophors, phenolics, disinfectant wipes *,†

Question 34

clean surfaces, knobs in office how?

Answer 34

detergent + water or disninfectant wipes

Question 35

what if stethoscope has blood on it?

Answer 35

use sodium hypochlorite diluted 1:10 to 1:100 or 70% to 90% alcohol.

Question 36

need to know what about phenolics?

Answer 36

should not be used for items that will be in direct contact with the skin of newborns.

Question 37

give 2 suggested admin policies

Answer 37

develop infection control policy and review every 2 years; ongoing education for personel; establish system fo communcation with public health

Question 38

3 things to incoproate in office design

Answer 38

avoid carpeting; ensure sinks + soap and waterless hand hygiene products avaialbe in all pt areas; signs with resp etiquette; ventilation at least 6 air changes per hour

Question 39

how can you triage pts?

Answer 39

- put immunocompromised pts in exam room right away - parents should tell receptionist right away if suspect child contangious - segregate symptomatic infectoius children ASAP - if travel alert for resp infectoius, ask about rravel ouside canada in past 21 days before sx (ask the same thing for household ocntacts)

Question 40

options for toys in waiting rooms:

Answer 40

- don't keep toys unless they can be appropiattely cleaned - ask parents to bring toys from home - provided only toys with smooth solid surfaces - ask parents to supervise kids and place used toys in designated bin for cleaning - provide books taht kids can take home or dispose of after use

Question 41

give 4x when personell should clean hands

Answer 41

- immed before/after pt contact - before moving to a clean body site from a contaminated body site during care of same pt - after contact with blood, body fluids - after directly touching a live vaccine - after touching a surface likely to be contaminated - before invasive procedures - after removing gloves

Question 42

alchohol based hand risnses should contain what % isopropyl or ehtyl alcohol

Answer 42

60-90% isopropyl or ethyl alchohol

Question 43

are gloves needed for giving vaccines?

Answer 43

no

Question 44

3 times when gloves are needed

Answer 44

If anticipating direct hand contact with blood, body fluids, secretions or excretions, or with items contaminated by any of these substances. For direct hand contact with mucous membranes or nonintact skin. For direct hand contact with a patient when the health care provider has an open lesion on the hand.

Question 45

how should spills be cleaned?

Answer 45

promptly and cleaned with detergent followed by bleach (a 1:10 to 1:100 dilution of household bleach, using the higher concentration for larger spills

Question 46

clean stethoscopes, otoscope handles how?

Answer 46

alcohol, disinfectant wipes, or soap and water

Question 47

pulse oximetry, base of thermoeter should be cleaned how often?

Answer 47

daily and when soiled

Question 48

computer mice and keyboards should be cleaned how often?

Answer 48

daily; consider these contaminated

Question 49

if examining table soiled with body fluids clean how?

Answer 49

1:100 bleach solution

Question 50

clean exam tables, tx chairs, sinks, door knobs how often?

Answer 50

daily

Question 51

washrooms could be cleaned how often?

Answer 51

daily

Question 52

clean surfaces taht are not usually an infection risk (eg: floors) how often?

Answer 52

weekly; but cupboards, walls, windows, air vents can be cleaned yearly

Question 53

disinfect toys how?

Answer 53

1:100 bleach + soap and water + air dry...or dishwasher

Question 54

toys should be cleaned how often?

Answer 54

between pts= ideal; otherwise, at end of the end

Question 55

preferred agent to clean skin for venipuncture and vaccines?

Answer 55

70% alcohol

Question 56

clean skin how for inserting IV catheter or doing invasive procedure or taking blood cultures?

Answer 56

2% chlorhexidine, chlorhexidine in 70% alcohol, 10% povidone-iodine or an alcoholic tincture of iodine should be used. Povidone-iodine should be left to dry for 2 minutes [2

Question 57

antiseptics should ideally be SINGLE use. if multi-use, do what?

Answer 57

label them with the date and discard after 28 days of use

Question 58

do what for pts with suspected measles, varicella, disseminated zoster or contagious TB?

Answer 58

- place directly in exam room - use a negative pressure room - keep exam room door closed

Question 59

for suspected measles or varicella (airborne precautions, NOT TB!), personnel should do what?

Answer 59

- no mask needed if immune | - if not immune, do not enter room

Question 60

after airborne-dx patient leaves room, do what?

Answer 60

- leave room for 70 min for air ventilation if 6 air changes/hour - or, if air exchange rate not known, only use room for immune pts for remainder of the day

Question 61

do what for droplet precuations (meningitis, pertussis, rubella, mumps, meningococcal infection)

Answer 61

- place in room immediately or separate from other pts from 1-2 m - have pt wear surgical mask when outside of the room (same for any resp infection); if infant, cover their nose with mouth and tissue

Question 62

for droplet transmission, when is eye protection needed?

Answer 62

should be considered for care of patients with respiratory tract infections (RTIs) who are coughing at the time of the interaction or if a procedure is performed that may result in coughing [1][5][6]. When eye protection is not available, wear gloves and keep hands away from the eyes during patient care.

Question 63

who needs contact precautions? (4)

Answer 63

Infectious diarrhea. Extensive, skin lesions which are not covered (e.g., varicella, zoster), or wound drainage not contained by dressings. Selected patients colonized with antibiotic-resistant organisms (AROs), such as MRSA and VRE (see below). Children with a documented or suspected viral RTI who cannot control their respiratory secretions adequately.

Question 64

how to manage antibiotic resistant organism?

Answer 64

-usually hand hygiene enough; consider contact precautions (case by case)

Question 65

do what for pts with suspected ebola?

Answer 65

- contact public health - if low risk (early stage or healing): droplet + eye + contact precuations - if advanced disease (bleeding, vomiting, incontiennce): more extensive protective apparel to cover ALL exposed skin. use airborne precautions for aerosol-generating procedures.

Question 66

5 things HCPs should be immune to

Answer 66

measles, mumps, rubella, varicella, hep B, polio

Question 67

what should HCP do if have cold

Answer 67

- go to work - no contact with high-risk pts - wear surgical mask - wash hands after contact with resp tract secretions and before every contact with pt/pt care equipment

Question 68

personnel with blood-borne viral infections should do what

Answer 68

not perform procedures with high risk of transmission of blood

Question 69

infections where not allowed to come to work

Answer 69

influenza, measles, mumps, pertussis, TB(active), varicella

Question 70

infections where restrictions in place until symptoms resolves/ lesiosn healed/crusted?

Answer 70

colds, gastroenttisi (or deemed not contagoius), HSV. herpetic whitlow, influena,MSSA (unless lesions covered), MRSA (and assessed for risk fo trnasmission), varicella,

Question 71

infections where can't work with pts

Answer 71

conjunctivitis, gastro, hep A, herpetic whitlow, pediculosis, scabies, MSSA if lesions on hands/can't be covered, MRSA, GAS, zoster if not covered

Question 72

infections where HCPS are exclused from working with high risk pts only

Answer 72

colds, HSV (if lesions not covered, includes babies adn nonimmune peopel), Zoster (even if lesions covered-- for babies, preg women, and nonimmune immunocomp pts)

Question 73

when can people with conjunctivitis work with pts again?

Answer 73

when exudates resolves

Question 74

when can ppl with hep A work with pts again?

Answer 74

1 week after onset of jaundice

Question 75

when can people iwth measles return to office?

Answer 75

4 days after onset of rash

Question 76

when can people iwth mumps return to office?

Answer 76

9 days after onset of parotitis

Question 77

when can people with pediculosis work with pts again?

Answer 77

when one treatment completed (<24h)

Question 78

when can people with pertussis return to work?

Answer 78

after antibx x 5 days

Question 79

when can ppl with rubella return to work?

Answer 79

7 days after onset of rash

Question 80

when can people with scabies return to pt care?

Answer 80

after one tx completed <24 h

Question 81

when can people with GAS return to pt care?

Answer 81

once treated for 24 h

Question 82

when can people dx'ed with active tb return to office?

Answer 82

when assessed as non-infectious

Question 83

who is considered a high risk pt?

Answer 83

hemodynamically significant congenital heart disease or chronic lung disease, neonates and immunocompromised patients.