Operative Suite

Question 1

The 15-year-old patient has mumps and is coming to surgery for an open reduction internal fixation of his tibia and fibula bones. What, if any, isolation precautions should be taken during the care of this patient?

Answer 1

Contact isolation is required

Mumps virus is transmitted via inhalation of infectious respiratory droplets, direct contact with infected droplets or saliva. Droplet precautions are required

Question 2

Sodium Hypochlorite

Answer 2

Bleach

used to clean the room after C-diff or
Creutzfeldt-Jakob disease (CJD) (allow 15 minute contact time)

Question 3

Sodium Hydroxide

Answer 3

Lye

also acceptable to use after a patient with CJD (60 minute contact time with instruments)

Question 4

A patient with Creutzfeldt Jacob disease has just left the OR. How should the room be cleaned?

Answer 4

Clean the room and surfaces with Sodium
Hypochlorite or Sodium Hydroxide

Question 5

How far should eye wash station be away from area working with hazardous materials?

Answer 5

10 seconds

Question 6

Creutzfeldt-Jakob disease (CJD)

Answer 6

Prions=proteins found in cells
Harmless unless misshapen or folded
Can be sporadic, hereditary, iatrogenic (from exposure to tissue), or variant (eating infected beef, blood transfusion)
Single use instruments
Should be last case of day
Do not use IUSS (immediate use steam sterilization)

Question 7

Injury reduction (effective to least effective)

Answer 7

-Elimination of the hazard
-Engineering controls,(ex: safety syringes)
-Work practice controls (ex: neutral zone)
-Admin controls (ex: policies, and procedures)
-PPE (ex: double gloving)

Question 8

Unrestricted

Answer 8

Locker rooms, lounge areas, control desk, pre and postop areas
Street clothes

Question 9

Semi-restricted

Answer 9

Storage for equipment and supplies, hallways with access to restricted areas to pre and postop, central processing
Clean scrubs, head covering, patient gowns, single use jumpsuits

Question 10

Restricted

Answer 10

Operating rooms, clean core/substerile
Mask in addition to the clean scrubs and head covering, head covering for patients

Question 11

How many times the air in a room is replaced?

Answer 11

20 air changes per hour

Question 12

ACH in restricted area

Answer 12

OR:
Total 20
Outside 4

Question 13

ACH in semi-restricted areas

Answer 13

Sterile storage: total 4, outside 2
Decontamination: total 6, outside 2

Question 14

ACH in unrestricted areas

Answer 14

PACU: total 6, outside 2
Procedure room: total 15, outside 3
Endoscopy: total 6, outside 2

Question 15

Humidity in all areas

Answer 15

20-60%
No recommendations for decontamination

Question 16

Negative pressure

Answer 16

For decontamination and isolation rooms
Pressure in hallways greater than in room
Air current moves from hall to room

Question 17

Laminar pressure

Answer 17

A type of positive pressure
Unidirectional, controlled from cleanest to less clean area of room
May be horizontal or vertical
Use for high-risk procedures (totals, transplants, hearts)

Question 18

Temperature in restricted areas

Answer 18

OR: 68-75 F

Question 19

Temp for semi-restricted areas

Answer 19

Sterile storage: none-75 F
Decontamination: 60-73 F

Question 20

Temps for unrestricted areas

Answer 20

PACU: 70-75 F
Procedure room: 70-75 F
Endoscopy: 68-73 F

Question 21

Cleaning for CJD (mad cow disease)

Answer 21

-Disinfect with sodium hypochlorite or sodium hydroxide dwell time 30-60 minutes
-Soak up solutions and discard per local/state/federal regulations
-Rinse treated surfaces with water

Question 22

Cleaning for TB

Answer 22

Restrict room access for 28 minutes where 15 air exchanges will happen
Removes 99% of bacteria

Question 23

2000 needle-stick safety and prevention act

Answer 23

A law for sharps safety

Question 24

Airborne precautions

Answer 24

N95 mask
Intubated in isolation room
-Bacterial filter on the ETT
If not intubated: portable industrial grade HEPA filter, PAS-HEPA (antechamber)

Question 25

Droplet precautions

Answer 25

Released during coughing, sneezing, and talking
PPE within 3 feet of patient
Regular mask
Precautions during transport: reverse isolation (pt with mask)
Example: influenza patient

Question 26

Contact precautions

Answer 26

PPE
Maintain precautions during transport
Adequate disinfectant and cleaning
Example: patient with multi-drug resistant organism (MDROs)

Question 27

MDROs examples

Answer 27

-MRSA
-VRE
-Vancomycin resistant staphylococcus aureus
-C.diff
-Klebsiella pneumoniae
-Carbapenem resistant Enterobacteriaceae

Question 28

Policies

Answer 28

-Must be in written form
-Reviewed annually
-Readily available to staff

Question 29

Disseminated herpes zoster (shingles) precautions

Answer 29

Airborne precautions

Question 30

Airborne precautions examples

Answer 30

-Rubeola (measles)
-Varicella (chicken pox): contact as well
-TB