Micro: Infection Control

Question 1

What did the high 5 campaign focus on?

Answer 1

preventing pt care hand-over errors
preventing wrong site/wrong procedure/wrong person surgical errors
preventing continuity of medication errors
prevention of high concentration drug errors
promotion of effective hand hygiene practices

Question 2

What are the different factors influencing HAIs?

Answer 2

patient, environment/equipment, system, pathogen, caregivers, process

Question 3

What are patient risk factors for HAI?

Answer 3

DM, obesity, decreased immunity (HIV, cancer, immunosuppression), malnutrition

Question 4

What are pathogen related risk factors for HAI?

Answer 4

virulence
antibiotic resistant bacteria
pathogens that form biofilms on catheters
pathogens transmissible from person to person (Tb, flu, staph)

Question 5

What are the different modes of transmission of different pathogens?

Answer 5

airborne - tb, n. meningitidis
contact - bacteria, viruses
water - gram - bacteria, legionella
bloodborne - HIV, HCV
parasites - lice, scabies

Question 6

What are the five moments for hand hygiene?

Answer 6

before patient contact
before aseptic task
after body fluid exposure risk
after patient contact
after contact w patient surroundings

Question 7

What are special types of contact precaution?

Answer 7

contact-D precautions: gloves/gown/*hand hygiene w soap and water/standard precautions
droplet precautions: rectangular mask/private room/hand hygiene/standard precautions
airborne precautions: N95 mask/negative pressure room/hand hygiene/standard precautions

Question 8

Which organisms typically require contact isolation?

Answer 8

MRSA
vanc resistant enterococci
highly resistant GNRs
put precautions on BEFORE entering room, take off BEFORE leaving room

Question 9

What are the criteria for airborne isolation?

Answer 9

pts w clinical/radiologic features suggestive of Tb
HIV inf pts w cough or any unexplained infiltrate on CXR
pts w antibiotic therapy who may still have active dz
pts receiving inadequate antibiotic therapy
pts w extrapulmonary tb lesions or abscess draining through skin

Question 10

What is the best method for minimizing risk of CAUTI?

Answer 10

aseptic insertion and maintenance
bladder ultrasound
condom or intermittent catheterization
do not unless you must
early removal

Question 11

What are some multi-drug resistant organisms?

Answer 11

MRSA
vanc resistant enterococci
resistant gram negatives
extended spectrum beta lactamase producing gram negatives (ESBL producers)
carbapenem resistant enterobacteriaceae
c. difficile

Question 12

What are some common blood borne pathogens?

Answer 12

hep B or C, HIV, malaria, brucellosis, syph, arboviral inf

Question 13

What is the doctrine of double effect?

Answer 13

justifies possibility of harming certain individuals to bring about other goods

Question 14

What is the precautionary principle?

Answer 14

justifies anticipatory preventive action despite incomplete scientific evidence

Question 15

What are the four fundamental best practices for for preventing HAI?

Answer 15

hand hygiene
standard precautions
isolation precautions
prudent antimicrobial use

Question 16

What are some limitations of the best practice approach?

Answer 16

wide variation in rate of infection
best practices don’t always lead to better outcomes
local practices may override best practice
changing human behavior and practice is complex
opportunities for cross-contamination

Question 17

What are the two broad categories of recommendations to reduce HAI?

Answer 17

technical and adaptive (comprehensive unit based safety program and positive defiance)
prevention can be vertical (pathogen specific) or horizontal (pathogen nonspecific)

Question 18

What is positive deviance?

Answer 18

learns from natural variation through thoughtful inquiry
positive deviant practices and behaviors and individuals from local collective intelligence are IDed
use of PD behaviors spread to other caregivers through peer-role modeling and education

Question 19

What are the two major differences between CUSP and PD?

Answer 19

PD assumes effective practices already exist and source of these practices is w/i the organization
PD turns conventional failure analysis approach on its head and focuses on analysis of success