midterm Flashcards
according to bankatis and kemp infection control refers to ….
the conscious management of the environment for the purposes of minimizing or eliminating the potential spread of disease
what does infection control invole
development, implementation, and execution of professions-specific protocols designed to reduce potential cross-contamination
what does the effectiveness of infection control depend on
degree to which protocols meet and the extent to which they are followed
background of hiv/aids
1980 : several cases of rare illnesses in men
1981 : CDC recognized hiv/aids as the cause
occupational safety and health administration (OSHA) and hiv/aids
developed guidelines for protecting healthcare workers from cross-infection of HIV and other blood borne diseases
universal precautions
all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other blood borne pathogens
guidelines for standard precautions
-appropriate personal barriers must be worn when performing procedures that may expose personnel to infection agents
-hands must be washed before and after every patient contact and after glove removal
-touch and splash surfaces must be pre-cleaned and disinfected
-critical instruments must be sterilized
-infectious waste must be disposed of properly
basis of the center for disease control (CDC) universal blood and blood borne pathogen precaution
stems from the underlying principle that every patient must be considered a potential carrier of an infection disease and/or a susceptible host for potentially infectious microorganisms
OSHA
department of labor established in 1971
-1991 implemented blood borne pathogens standard
joint commission accreditations for the healthcare organizations (JCAHO)
set guidelines based on OSHA standard which vary depending on the type of facility
-independent
-quicker reimbursement from 3rd party insurance
environmental protection agency (EPA)
mission : protect human health and environment
-regulate and register disinfectants and sterilants
food and drug administration (FDA)
responsible for protecting the public health by ensuring the safety of drugs, biological products, and by ensuring the safety of our nations foods supply
epidemic
sudden outbreak
-more than usual cases of a disease occurs
-ex. outbreak of cholera, yellow fever
pandemic
an epidemic on a large scale
-ex. covid
endemic
an infection that is ever present at a relatively low level
-ex. malaria
normal flora
bacteria which are found in or on bodies on a semi-permanent basis without causing disease
-viruses and bacteria are NOT normal flora
benefits of normal flora
-competes with pathogens
-certain B vitamins and vitamin K
-produces substances which inhibit or kill pathogens
-acts as antigens and stimulates low levels of antibodies to prevent infection or invasion
how much normal flora is in our bodies
10^14
-when compared to 10^13 for cells
helpful microbes in our bodies
normal flora and probiotics
pathogens
microbes that due harm
-essential to kill as many as possible to prevent the spread of disease
when do diseases occur
when normal flora is suppressed and pathogens can grow
harmful aspects of normal flora
-takes advantage of immunocompromised host
-occurs when the organisms are at a site with which they are not normally associated (ex. e.coli is normal of GI tract but causes UTI’s if in urinary tract)
nosocomial infections
hospital acquired
example of nosocomial infection (MRSA)
-since introduction of antibiotics, there has been antibiotic-resistant strains (MRSA)
-these strains are responsible for many infections
-patients are more susceptible to acquiring infections
-hospital staff may serve are vectors of infection
-special cleaning agents are needed to kill MRSA
methicillin-resistant staphylococcus aureus (MRSA)
bacterium responsible for difficult to treat infections in humans
-hospital acquired
do antibiotics help kill viruses
they do not help viral infections
-antibiotics only treat bacterial infections
-there are a few antiviral medications
what can antibiotic overuse lead to
MRSA
-more harm than good
organisms more likely to be acquired within a hospital
staphylococcus-aureus, pseudomonas aeruginosa, enteric gram negative rods, hep B, hep C, HIV, candida infections
prokaryotes
“before nucleus”
-usually single celled
-lack an organized nucleus
-no mitochondria or chloroplasts
-bacteria
eukaryotes
-usually multicellular
-true membrane bound nucleus
-mitochondria and chloroplasts
-DNA organized in chromosomes
-protozoa, fungi, plants, and animals
immune system cells
white blood cells, red blood cells, and platelets
where do immune system cells develop
in the bone marrow from hematopoietic stem
white blood cells (leukocytes)
lymphoid lineage and myeloid lineage
lymphoid lineage
-primitive T cells go to thymus to mature
-primitive b cells stay in bone marrow to mature
-natural killer cells
myeloid lineage
-mononuclear phagocytes, monocytes, macrophages, granulocytes, basophilis, platelets, and others
B cells
matures in bone marrow
-receptor cells on their surface recognize foreign pathogens
-produce antibodies
-present antigens to T cells
T cells
mature in thymus
-helper and killer t cells destroy the foreign bodies after the B cells have identified them
-signal to B cells to start humoral immunity
methods of transmission
contact, common vehicle, air, and vector
contact transmission
direct - person to person contact
droplets - travel short distance through the air
common vehicle transmission
indirect transmission by food, water, biologic products (blood), and fomites (inanimate objects)
-contaminated needles, instruments, specula, HA, earmolds, etc.
airborne transmission
infectious agents carried by dust, skin shed or droplet suspended in air
-can be over great distances
vector transmission
arthropods
-external : organism is carried mechanically on the vector
-internal : organism is carried within the vector
herpesviridae
DNA viruses
herpes simplex 1 and 2, varicella zoster
HSV 1
saliva
-acute gingibostomatitis, cold sores/fever blisters
HSV 2
sexual contact
-genital herpes, neonatal herpes, viral meningitis
varicella zoster
varicella (chicken pox) and zoster (shingles)
herpes zoster oticus
ramsay-hunt syndrome
-viral infection of the facial nerve near the ear
-can cause ear pain, hearing loss, dizziness, and facial pain
meningitis
inflammation of the protective layers of the brain and spinal cord
causes of meningitis
viral, bacterial, fungal, and parasitic
symptoms of meningitis
initial : headaches, fever, stiff neck, light sensitivity, and lethargy
severe : confusion, seizures, coma or death
viral meningitis
most common but less severe than bacterial
-non polio enteroviruses
-spread by close contact
-recovery occurs within 7 to 10 days
bacterial meningitis
more severe than viral
-can be fatal
-can cause brain damage, hearing loss, and learning disabilities
-streptococcus pneumoniae, group B streptococcus
-spread by close contact, from mother to child, or through food
-hospitalization, antibiotics, and supportive measures
fungal meningitis
rare, typically only affects immunocompromised
-spreads through the bloodstream to the brain and spinal cord
-acquired within hospitals
-anti-fungal medication
critical instruments
instruments that come into contact with blood and/or other infectious substances
non-critical instruments
earmolds, headphones, specula, toys, keyboards, microphones, shared pends/pencils, in the ear hearing aid styles
general procedure for critical items sterilizatin
-cold sterilization for audiologic implements
-soak in 2% glutaraaldehyde for 10 hours
-soak in 7.3% hydrogen peroxide for 6 hours
cleaning
gross contamination is removed but germs might not be
sanitizing
gross contamination removed, some germs killed
-hard to say which microbes are being removed
-avoid in healthcare setting
disinfecting
killing the germs
-low is household
-mid is that of dishwasher pods, alcohol, and bleach
-high is hospital grade
sterilization
kill 100% of vegetative microorganisms and their endospores 100% of the time
hand hygiene is the ….
single most important procedure for limiting the spread of infectious disease
when must hands be washed
before and after every single patient contact and after glove removal
what type of water is best for washing hands
warm water
type of soap that is best
antimicrobial soap for operating rooms
-avoid bar soap
what does universal precaution recommend for hand washing
soap and water, but more recently hand sanitizer is allowed as long as there is no visible contaminants
-bankaitis for 10 sec
-CDC for 20 sec
-OSHA for 20 to 30 sec
hand sanitizer is ….
only acceptable if there are no visible contaminants or debris
-alcohol based
innervation
auricle and ear canal have branches of 5, 10 and cervical plexus
-branches from 7 and 9
-precise distribution of nerves is not constant
external canal sensitivity
-superior and anterior are less sensitive
-inferior and posterior are more sensitive
with canal sensitivity, what is the recommendation for instrument removal
remove at the superior aspect of impaction
what may stimulation of nerves cause
discomfort, coughing, watery eyes, syncope, cardiac depression, dizziness, and sneezing
neuro-reflexes of the external auditory meatus
vagus, trigeminal, lymphatic
trigeminal reflex
“red reflex”
-causes excessive vascularization and thickening of the TM
-can be evoked by otoscopy, otoblock insertion, and hearing aid use
vagus reflex
“arnold’s reflex”
-coughing, gagging, and/or watering of the eyes
-can be evoked by insertion of otoblock, cerumen removal, or insertion of hearing aid
lymphatic reflex
slow reflex which could result from over-wearing of hearing aids during adaptation period
-causes swelling of tissues and soreness
-may appear to be due to an allergic reaction
hearing evaluation protocol with no concerns
-wash hands
-case history
-gloves or no gloves (up to you)
-attach specula
-visually inspect both ears with one specula
-remove specula with gauze
-dispose of specula or sterilize
-perform hand hygiene
hearing evaluation protocol with concerns
-wash hands
-case history/drainage
-gloves
-attach specula
-visually insert health ear then the ear of concern OR replace specula prior to inspection
-remove specula with gauze
-dispose of specula
when should you switch the specula
if looking in a ear with concern first or you feel as if it got contaminated
parts of the tympanic membrane
pars flaccida, light reflex, manubrium, umbo, and pars tensa
otomycosis
fungal infection of the ear
-accounts for 10-20% of outer ear infections
-higher incidence in warmer climates
-use of topical steroids and antibiotics are a predisposing factor
what is the leading cause of germs transmitting in health care?
contaminated hands
glove fit
snug
-allow for movement
-not too loose or too tight
otitis media
inflammation of the ear
abrasion of canal
cuts within canal
