Infection Prevention & Control

Question 1

How far can respiratory droplets travel?

Answer 1

• small droplets evaporate to droplet nuclei, which can be carried in air for minutes to hours
• larger droplets will settle to the ground in a few seconds but can travel up to 4 m away

Question 2

Routine practices should be determined by…

Answer 2

The interaction with the patient not by the patient’s diagnosis, with the anticipation of risk of exposure to bodily fluids
- all body substances of all patients are considered potentially infective

Question 3

Routine practices should be used in conjunction with…

Answer 3

Additional precautions baed on the method of transmission

Question 4

When are additional precautions required?

Answer 4

• droplet, contact and airborne transmission
• bacteria that are resistant to multiple antibiotics
• organisms or infections of significance

Question 5

What is the most effective way to break the chain of transmission?

Answer 5

Hand hygiene

Question 6

What is the most sensible strategy for hand hygiene in non-healthcare settings?

Answer 6

Soap and water

Question 7

What are the four moments for hand hygiene?

Answer 7

1) before initial patient contact
2) before aseptic procedure
3) after bodily fluid exposure risk
4) after patient contact

Question 8

When should a mask and eye protection be used?

Answer 8

• risk of spraying or splashing of bodily fluids

- within 2 metres of a coughing patient

Question 9

When is a single room required?

Answer 9

• patient visibly soils environment

Question 10

How are hepatitis B, hepatitis C, and HIV transmitted?

Answer 10

Only via blood

Question 11

Overall, what is the risk of acquiring HBV, HCV and HIV post exposure to blood?

Answer 11

• very little
• HBV 6%-30% if not vaccinated
• HCV 1.8% after cut or needle stick
• HIV 0.1%-0.3% after needle stick, cut or splashes to mucous membranes

Question 12

How is blood borne pathogen risk prevented, eliminated and reduced?

Answer 12

Risk prevention - HBV vaccine, maintain intact skin, maintain good health
Risk Elimination - disinfection, safe containment of blood
Risk reduction - PPE

Question 13

Examples of airborne diseases

Answer 13

• measles
• pulmonary or laryngeal TB
• rash with measles presentation

Question 14

What are airborne precautions?

Answer 14

• single room, door closes at all times
• negative pressure
• 6-9 air changes per hour
• new construction - 12 air changes
• direct exhaust (air from room is not recirculated)
• N95 respirator
• patient only leaves room for essential procedures and wears surgical mask

Question 15

Examples of droplet transmitted diseases

Answer 15

• colds
• bacterial meningitis
• diphtheria
• pertussis
• RSV
• adenovirus
• influenza

Question 16

What are droplet precautions?

Answer 16

• droplets often contaminate the patient environment, single room preferred
• if not, spatial separation of 4 metres
• may cohort patients with same diagnosis
• in nurseries, must keep 1-2 metres between bassinettes
• door can be open
• surgical mask, eye protection
• gown and gloves if exposure to respiratory secretions
• patient only leaves room for essential services and must wear mask

Question 17

Examples of contact transmitted diseases

Answer 17

• enteric organisms such as C. difficile

- MRSA, VRE, ESBL, etc.

Question 18

What are contact precautions?

Answer 18

• gown and gloves for patient care and when handling patient’s personal items
• single room preferred
• door can be open
• assess patient, organism and roommate if shared accommodation
• clean environment
• may leave room for necessary procedures
• patient should be transported with clean gown and sheet and perform hand hygiene upon leaving the room

Question 19

What is the most common serious complication of hospitalization?

Answer 19

Hospital acquired infections

- 4th leading cause of death in Canada, has risen from 11th

Question 20

What are the most common nosocomial infections?

Answer 20

• UTI and pneumonia, followed by surgical site and bloodstream

Question 21

How are surgical wound classified?

Answer 21

Class I - clean
Class II - clean contaminated
Class III - contaminated
Class IV - dirty (expected infection rate > 20%)

Question 22

What us the most common source of microorganisms?

Answer 22

Skin

Question 23

What are pre-operative prevention strategies for surgical wound infections?

Answer 23

• pre-op showers
• hair removal
• skin antiseptic
• drapes
• prophylactic antibiotics

Question 24

What are intra-operative prevention strategies for surgical wound infections?

Answer 24

• aseptic operative technique
• OR traffic and keeping doors closed
• duration of procedure (shorter is better)
• insertion of drains, catheters and IVs increases risk

Question 25

What OR attire is required?

Answer 25

- surgical scrubs - mask - gown - gloves - caps - shoe covers (for non-wipeable shoes)

Question 26

What cleaning procedures are necessary in the OR?

Answer 26

- between surgeries: horizontal surfaces, 1 m radius around OR table - daily: full floor, lights, walls - weekly: shelves, external vents - monthly: hallways, other storage areas - sterilization and disinfection of instruments (critical, semi-critical and non-critical items)

Question 27

What are the infection risk sites of IV therapy?

Answer 27

- hands of HCP - patient's skin microflora - contaminated IV on insertion - hub colonization - contaminated fluid - hematogenous spread

Question 28

IV risk is based on...

Answer 28

- site - prep - aseptic technique - daily observation - preparation of IV fluids - duration fo IV left insitu

Question 29

How can UTIs from catheterization be prevented?

Answer 29

- catheter insertion is a sterile procedure - the use of catheters should be kept to a minimum - daily peri- care (soap and water) - maintain medical aseptic technique when emptying catheter and obtaining urine samples - keep catheter bag below patient’s hips to reduce the potential for backflow - select the type of catheter appropriate for the duration of use

Question 30

What is nosocomial pneumonia?

Answer 30

- pneumonia not present or incubating at the time of admission - no incubation within the first 48-72 hours of hospitalization - accounts for 10-20% of all HAIs - has highest morbidity of all HAIs - may be due to bacteria, virus or fungi - bacterial HAP spread primarily by aspiration, inhalation of aerosols, or hematogenous spread - viral HAP reflects the prevalence of virus in the community, but does not predominantly hit the high risk group - fungi and unusual bacteria only poses risk to immunocompromised and transplant cases

Question 31

How does hospital environment play a role in HAIs?

Answer 31

- construction, renovations, and water features | - examples include legionella and aspergillus

Question 32

What are risk factors for HAP?

Answer 32

- thoracic and thoraco-abdominal operations - age (>60 years) - patients who aspirate d/t reduced LOC, dysphagia, or those with NG tube - reduced ability to cough - patients having invasive procedures - patients colonized with gram negative bacilli, such as those with COPD, CF and prolonged intubation - immunocompromised patients

Question 33

How can HAP be prevented?

Answer 33

- personnel – healthy workplace and immunization - aseptic technique for procedures - antiseptic mouth wash /oral care - patient positioning; care with feeding - barrier precautions - pre/post-op teaching - disinfection practices - environmental issues (e.g. construction)

Question 34

What is antiseptic?

Answer 34

- used on living tissue

Question 35

What is disinfectant?

Answer 35

- reduces microorganisms and may eliminate some - does not eliminate bacterial spores - thermal and chemical methods - used on inanimate objects

Question 36

What is sterilization?

Answer 36

- kills all microorganisms including spores | - must be preceded by cleaning

Question 37

What is the order in which microbes or eliminated?

Answer 37

1) sanitation 2) decontamination 3) disinfection 4) sterilization

Question 38

What is a "critical item"?

Answer 38

- will enter sterile body cavity or come in contact with sterile tissue or vascular system, or blood will flow through them - require sterilization - example: surgical instruments

Question 39

What is a "semi-critical item"?

Answer 39

- they only come in contact with mucous membranes or non intact skin - requires, at minimum, high level disinfection - example: endoscopes, anaesthetic equipment

Question 40

What are "non-critical items"?

Answer 40

- items that come into contact with intact skin - require sanitization - example: urinal

Question 41

What is decontamination?

Answer 41

- removes blood, body fluids, and tissue in order to ensure sterilization process - makes items safe to handle

Question 42

What is low level disinfection?

Answer 42

- can kill most bacteria and some viruses and fungi (mycobacterium TB) - used for cleaning general patient care areas, bedside, IV pole, etc. - household cleaning products and bleach

Question 43

What is high level disinfection (HLD)?

Answer 43

- destroys all micro-organisms including vegetative bacteria, tuberculosis, yeasts and viruses, except some bacterial spores - used to disinfect flexible scopes and small items in out-patient clinics - example: Glutaraldehydes, Ortho-phthaldehyde (OPA) - requires special ventilation and PPE for staff - new technology: ultraviolet (UV) light HLD

Question 44

What types of sterilization exist?

Answer 44

- steam under pressure - dry heat - ethylene oxide gas - chemical sterilants - sterilizes in 10 to 12 hours (ex. glutaralderhyde (Cidex)) Newer technology: - thermal disinfectant (water at 93 C for 10 min) - hydrogen peroxide vapor - hydrogen peroxide gas plasma (Sterrad) - peracetic acid (Steris) - ozone (testing underway)

Question 45

What is pasteurization?

Answer 45

- reduces number of microorganisms by mechanical means using thermal disinfection (hot water 75-82 C for 30 min - typically used for respiratory equipment

Question 46

Disposable use vs. single use vs. single patient use?

Answer 46

- Disposable = use once and discard - Single use = use only once and discard - Single patient use = use repeatedly for same patient and discard upon patient discharge

Question 47

Why is reusing single use medical devices an issue?

Answer 47

- antibiotic resistant organisms - cleaning of new complex instruments - reprocessing single use devices - impact of construction (dust, water, ventilation)