Module 5/6 Flashcards
Who should use routine practices?
All healthcare workers.
When are routine practices used?
Whenever you expect to have contact with:
Body fluid (except sweat)
Mucous membranes
Nonintact skin
What fluids are included in routine practices?
All but sweat.
What are recommended for use during routine practices?
Hand washing
PPE
Patient care equipment
Environmental control
Linen
Occupational health and blood borne pathogens
Patient placement
When are gloves used?
Touching body fluids
Touching contaminated items
Performing invasive procedures
Performing tests
Handling patient specimens
Touching mucous membranes or broken skin
When should gloves be removed?
After use
Between patients
When soiled/damaged
When touching noncontaminated items or surfaces
If heavily contaminated
What is contact dermatitis and why is it a problem?
Caused by an allergy, results in broken skin.
Breaks the protective barrier of the skin, S. aureus infections can create a reservoir of bacteria.
When are masks worn?
If there’s a danger of aerosols or splashes of infectious material.
What types of masks are there?
Procedure/surgical- expandable, filter 95% efficiency
What else can gloves be used for?
Creating a waterproof dressing.
What masks must be fit tested?
HEPA
N95
How are masks used?
Metal nosepiece at top
Coloured side out (fluid resistant)
Replace if wet
Tie top first
Untie bottom first
When are goggles/face shields used?
When there is danger of infectious material on the mucous membranes of the eyes, nose or mouth.
What types of face protection are there?
Goggles- surround eye area
Safety glasses- impact protection but less splash/droplet
Face shield- protect eyes, made and mouth
Full face respirators
When are gowns worn?
If there is danger of contamination with infectious materials.
To prevent the transfer of microbes between patients.
When noted in the door.
If the patient has MRSA.
What types of gowns are there?
Cloth, paper or plastic
Nonsterile
Sterile
How do you don and doff PPE?
Donning: hand hygiene, gown, mask, eye/face protection, gloves
Doffing: gloves, gown, hand hygiene, eye/face protection, mask, hand hygiene
What does hand hygiene refer to?
Soap and water- whenever hands are visibly soiled
Alcohol based hand rubs
Why is hand hygiene important?
Prevents nosocomial infections, most important procedure.
When should hand hygiene be preformed?
When hands contact body fluids or contaminated equipment
Before/after gloves
After a tear/leak in gloves
Before leaving work area
Between patients
After the bathroom or personal care
Before/after eating
At the end of the shift
What are the four moments of hand hygiene?
Before patient/environment contact
Before aseptic procedure
After body fluid exposure
After patient/environment contact
What types of sops re used for hand washing?
Nonantibacterial- reduces surface tension so bacteria is washed away, routine
Antibacterial- reduces surface tension and kills some microbes, critical care, nurseries, ER, OR, delivery and medication, burn/dialysis/transplant, after ARO contact
What is the best hand sanitizer?
70% ethanol or isopropyl
How are needle injuries prevented?
Activate safety device
Discard immediately
Use puncture resistant container
How is broken glass cleaned up?
Uncontaminated- broom/dustpan or wet paper towel, discarded
Contaminated- decontaminate for 10 min before cleaned up, put in biohazard broken glass
How are large/moderate body fluid spills cleaned up?
Wear PPE
Contain the spill
Sweep/scoop/wipe up
Biohazard discard
Decontaminate for 10 min
How do you clean up small spills?
Gloves
Moisten if dried
Wipe with disinfectant
Discard in biohazards
How are specimen spills cleaned?
PPE
Decontaminate with disinfectant for 10 min
Decontaminate surface with fresh disinfectant for 10 min
What is considered biohazardous waste?
Anything contaminated with body fluids
How are specimens transported?
In sealed containers
What is considered occupational/significant exposure to body fluids?
Skin is pierced by a contaminated sharp
Splash on mucous membrane
Contact with nonintact skin
Human bite
What is the protocol for significant exposure?
First aid
Allow bleeding
Wash
Bandage
Flush surface with water
Report to supervisor, who reports to occupational health
Go to emergency
What info should be included in a report of significant exposure?
Route of exposure
Source
Volume
Times since injury
Extent of injury
Type and promptness of treatment
Hep B immunization status
What are standard/routine practices?
Measures of protection applied consistently to all patients to protect workers, patients and visitors.
Who implements routine practices?
Infection protection and control practitioners.
Why and when are transmission based precautions used?
To minimize the spread of infection.
Separates patients with transmissible infections.
Protects immunocompromised patients.
What are the types of transmission based precautions?
Airborne- transmitted by droplet nuclei
Droplet- transmitted by droplets
Contact- transmitted by direct or indirect contact
What are the types of isolation rooms?
Negative pressure- air flows into room, keeps microorganisms from leaving, protects others, HEPA filtration
Positive pressure- air can flow out of the room, protects immunocompromised patients, reverse isolation/protective environment
How are items from isolation rooms discarded?
Permanent equipment is left
Equipment removed is bagged for discard or transported to be cleaned
How are isolation patients moved?
Try not to
Appropriate PPE
Protect wheelchair
Notify receiving department
What is sterilization?
Destruction of all microbial life (including spores, but not prions)
What is disinfection?
Destruction of pathogens but not all microorganisms.
Several levels.
Usually chemical.
What is terminal disinfection?
Disinfection after a patient leaves the area.
What is antisepsis?
Mild disinfection for living tissue.
What is sanitation?
Disinfection of eating utensils and dishes.
Mechanical or chemical.
What is cleaning?
Removal of soul/body secretions.
What are SUDs?
Single use devices.
What needs to be sterile?
Anything contacting sterile body tissue.
Containers to collect patient specimens.
Contaminated materials before disposal.
What are the methods of sterilization?
Incineration- terminal decontamination of waste, burns at high temps, off site
Autoclave- steam under pressure (121°C, 15psi, 15 min)
Ethylene oxide- gas sterilization, heat sensitive items, 8hrs, toxic
What items can be sterilized using autoclave?
Surgical instruments
Dressings
Surgical gowns
Anything that can withstand heat
Not good for plastics or rubber
How are autoclaves checked to ensure they are sterilizing adequately?
Spore strips
If growth occurs afterwards the spores aren’t killed and the autoclave isn’t working properly.
What properties are looked for in a disinfectant?
Broad spectrum
Rapid action
Resistance to inactivation
Nontoxic, odourless, nondestructive
Residual action
User friendly
Economical
What are the Spaulding classification of items requiring disinfection/sterilization?
Critical- must be sterile
Semi-critical- no pathogens
Non-critical- no inhalable microbes
How resistant are microbes to disinfection?
Vegetative bacteria- least
Lipid viruses
Fungi
Nonlipid viruses
Tubercle bacilli
Bacterial spores- most resistant
What are the levels of disinfection?
Low- kill vegetative cells and lipid viruses
Intermediate- everything except nonlipid viruses and spores are killed
High- everything is killed given sufficient time, essentially sterilants
Items sterilized with liquid chemical would be termed what?
Critical items
If disinfectant residue is removed with water that isn’t sterile what is the item termed?
Semi-critical
What are examples of low level disinfectants and their properties?
Soaps/detergents- cleaning and skin antisepsis, economical, efficacy decreases with heavy load, wetting agents
Quatenary ammonium cpds (zephiran)- synergistic with other products, wetting agents, some antibacterial action (G+), economical, inactivated by soaps, detergents, hard water, fibres, organic material
What are examples of intermediate level disinfectants and their properties?
Alcohols (70% isopropyl ethanol)- skin antisepsis, tops of vials, kills bacteria and lipid viruses but not HBV, no resistance, not effective with heavy loads, must check expiry dates
Chlorine (bleach)- Arron or weak, known biological spill contamination, routine disinfection, kills everything but spores, 10min, dilute daily, doesn’t work for metal, rubber or plastic, inactivates BBP
Iodophores (preodyne betadine)- skin antisepsis, cleaning, broad spectrum but not HBV, diluted daily, allergies, tincture = with alcohol, povidone = with detergent
Complex phenolic cpds (chlorohexidine gluconate or hexachlorophen-phisohex)- hand washing/skin antisepsis, broad spectrum, doesn’t kill spores, toxic (not used on newborns), critical care units
What are examples of high level disinfectants and their properties?
Glutaraldehyde (cidex, cold spore)- rubbers, plastics and metals, equipment sterilization, broad spectrum, toxic, expensive, disinfects in 10min, sterilized in 10hr, can’t sterilize critical items
Peroxygens (h2o2, peracetic acid)- heat sensitive objects, endoscopes, 3% disinfects, 25% sporicidal
What is pasteurization?
Intermediate level of disinfection using moist heat (75-77°C) for 30 min.
Kills everything but spores.
What is pasteurization primarily used for?
Reusable tubing from respiratory equipment.
Not hospital- milk products
What is filtration?
The removal of microorganisms from liquids and air by the use of filters with small pores.
What types of filters are there and what are they used for?
Membrane- remove microorganisms from fluids, IV solutions, drugs, lines of respiratory equipment to keep patient bugs from contaminating the environment and parts of the equipment
HEPA- air filtration, convoluted passages removes smaller microorganisms, isolation rooms, BSCs
What are microfibre cloths used for?
Environmental cleaning of surfaces, trap microorganisms in the fibres.
How is UV light used for microbial control?
Inactivates viruses and destroys some bacteria (not spores).
Reduces the number of airborne microorganisms.
Direct exposure required.
Water treatment.
How is ionizing radiation used for microbial control?
Destroys microorganisms in blood products for transfusion or food for immunocompromised patients.
What is moist heat and how does it prevent microbial growth?
Boiling
Destroys most microorganisms in 10min.
Not effective against spores, 6-8hrs to destroy botulism.
2% bicarbonate can increase effectiveness.
What is the purpose of aseptic technique?
Prevention of sepsis in patient.
Keep sterile materials sterile.
What are the applications of aseptic technique?
Removing sterile solution from vial for injection.
Removing a sterile swab, collecting patient sample and returning it to the package for transit.
Removing sterile dressings from package for patient use.
