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Introductory Microbiology > Infection Prevention & Control > Flashcards

Infection Prevention & Control Flashcards

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1
Q

How far can respiratory droplets travel?

A
  • 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
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2
Q

Routine practices should be determined by…

A

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

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3
Q

Routine practices should be used in conjunction with…

A

Additional precautions baed on the method of transmission

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4
Q

When are additional precautions required?

A
  • droplet, contact and airborne transmission
  • bacteria that are resistant to multiple antibiotics
  • organisms or infections of significance
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5
Q

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

A

Hand hygiene

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6
Q

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

A

Soap and water

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7
Q

What are the four moments for hand hygiene?

A

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

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8
Q

When should a mask and eye protection be used?

A
  • risk of spraying or splashing of bodily fluids

- within 2 metres of a coughing patient

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9
Q

When is a single room required?

A
  • patient visibly soils environment
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10
Q

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

A

Only via blood

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11
Q

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

A
  • 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
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12
Q

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

A

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

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13
Q

Examples of airborne diseases

A
  • measles
  • pulmonary or laryngeal TB
  • rash with measles presentation
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14
Q

What are airborne precautions?

A
  • 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
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15
Q

Examples of droplet transmitted diseases

A
  • colds
  • bacterial meningitis
  • diphtheria
  • pertussis
  • RSV
  • adenovirus
  • influenza
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16
Q

What are droplet precautions?

A
  • 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
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17
Q

Examples of contact transmitted diseases

A
  • enteric organisms such as C. difficile

- MRSA, VRE, ESBL, etc.

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18
Q

What are contact precautions?

A
  • 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
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19
Q

What is the most common serious complication of hospitalization?

A

Hospital acquired infections

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

20
Q

What are the most common nosocomial infections?

A
  • UTI and pneumonia, followed by surgical site and bloodstream
21
Q

How are surgical wound classified?

A

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

22
Q

What us the most common source of microorganisms?

A

Skin

23
Q

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

A
  • pre-op showers
  • hair removal
  • skin antiseptic
  • drapes
  • prophylactic antibiotics
24
Q

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

A
  • aseptic operative technique
  • OR traffic and keeping doors closed
  • duration of procedure (shorter is better)
  • insertion of drains, catheters and IVs increases risk
25
Q

What OR attire is required?

A
  • surgical scrubs
  • mask
  • gown
  • gloves
  • caps
  • shoe covers (for non-wipeable shoes)
26
Q

What cleaning procedures are necessary in the OR?

A
  • 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)
27
Q

What are the infection risk sites of IV therapy?

A
  • hands of HCP
  • patient’s skin microflora
  • contaminated IV on insertion
  • hub colonization
  • contaminated fluid
  • hematogenous spread
28
Q

IV risk is based on…

A
  • site
  • prep
  • aseptic technique
  • daily observation
  • preparation of IV fluids
  • duration fo IV left insitu
29
Q

How can UTIs from catheterization be prevented?

A
  • 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
30
Q

What is nosocomial pneumonia?

A
  • 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
31
Q

How does hospital environment play a role in HAIs?

A
  • construction, renovations, and water features

- examples include legionella and aspergillus

32
Q

What are risk factors for HAP?

A
  • 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
33
Q

How can HAP be prevented?

A
  • 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)
34
Q

What is antiseptic?

A
  • used on living tissue
35
Q

What is disinfectant?

A
  • reduces microorganisms and may eliminate some
  • does not eliminate bacterial spores
  • thermal and chemical methods
  • used on inanimate objects
36
Q

What is sterilization?

A
  • kills all microorganisms including spores

- must be preceded by cleaning

37
Q

What is the order in which microbes or eliminated?

A

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

38
Q

What is a “critical item”?

A
  • 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
39
Q

What is a “semi-critical item”?

A
  • they only come in contact with mucous membranes or non intact skin
  • requires, at minimum, high level disinfection
  • example: endoscopes, anaesthetic equipment
40
Q

What are “non-critical items”?

A
  • items that come into contact with intact skin
  • require sanitization
  • example: urinal
41
Q

What is decontamination?

A
  • removes blood, body fluids, and tissue in order to ensure sterilization process
  • makes items safe to handle
42
Q

What is low level disinfection?

A
  • 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
43
Q

What is high level disinfection (HLD)?

A
  • 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
44
Q

What types of sterilization exist?

A
  • 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)
45
Q

What is pasteurization?

A
  • reduces number of microorganisms by mechanical means using thermal disinfection (hot water 75-82 C for 30 min
  • typically used for respiratory equipment
46
Q

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

A
  • 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
47
Q

Why is reusing single use medical devices an issue?

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

Introductory Microbiology (11 decks)

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