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Ash's Certification Study > Pa Doh Env Of Care > Flashcards

Pa Doh Env Of Care Flashcards

1
Q

All aspects of the healthcare env

A

Environment of care

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2
Q

Components of the environment of care

A
  • Environmental Cleaning
  • Healthcare textile services
  • maintenance and engineering
  • heating, ventilation, and air conditioning
  • waste management
  • water systems
  • construction and renovation
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3
Q

Non regulatory agencies involved with the env of care

A

CDC
APIC
AORN
AHE

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4
Q

Regulatory agencies involved with the environment of care

A

CMS
OSHA
FDA
TJC

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5
Q

____ ensure regulatory compliance in healthcare facilities

A

audits

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6
Q

The process of removing visible dirt, organic material, and debris from surfaces and objects

A

Cleaning

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7
Q

The process of killing or inactivating microorganisms on surfaces and objects

A

Disinfection

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8
Q

Destroys all microorganisms including bacterial spores

A

Sterilization

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9
Q

What are the two groups for environmental cleaning?

A

High touch surfaces
Low touch surfaces

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10
Q

These require frequent cleaning due to the frequent handling and the risk of infection transmission

A

High-touch surfaces

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11
Q

Examples of high-touch surfaces

A

-Medical equipment knobs/ handles
- blood pressure cuffs
- bedrails
- doorknobs
- light switches

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12
Q

Examples of low-touch surfaces

A

-floors
-walls
-window curtains
-lights
-ventilation grills

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13
Q

What are the two zones related the healthcare?

A

Patient zone
Healthcare zone

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14
Q

This healthcare zone includes the patient and their immediate surroundings

A

Patient zone

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15
Q

This zone includes all areas outside the patient zone, like a waiting room

A

Healthcare zone

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16
Q

All healthcare facilities require cleaning, and all healthcare facilities should have cleaning _______________

A

Policies and procedures

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17
Q

Cleaning policies: customization

A

customize to facility’s needs and regulatory compliance

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18
Q

Cleaning policies: specifics to address

A

Departmental concerns
specify protocols
list agents and equpment

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19
Q

Cleaning policies: schedule

A

Set cleaning schedule and quality control

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20
Q

Cleaning policies: collaboration

A

Collaboration between multidisciplinary stakeholders

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21
Q

Cleaning policies: guidance

A

Follow guidance from reputable agencies like Association for Healthcare Environment (AHE)

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22
Q

Cleaning policies: Implementation

A

Implement systematic cleaning procedures

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23
Q

Cleaning procedures: where to clean first

A

Clean from less soiled to more soiled areas and from high to low surfaces

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24
Q

Cleaning procedures: when to clean

A

Clean promptly after device/ equipment use

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25
Q

Cleaning procedures: separation of items

A

separate reusable items from disposables

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26
Q

cleaning procedures: precautions for handling equipment

A

Standard precautions

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27
Q

cleaning procedures: what to use to clean

A

Detergents or enzymatic cleaners

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28
Q

cleaning procedures: considerations for manual/ automatic

A

Consider manual instrument, mechanical, or automatic cleaners for safety and efficiency

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29
Q

cleaning procedures: order cleaning/ disinfection

A

Cleaning before disinfection

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30
Q

What solutions are typically used for cleaning?

A

Detergent or cleaning agent and water

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31
Q

this reduces the overall microbial load, but may not eliminate all pathogens

A

Cleaning

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32
Q

What solution does disinfection typically use?

A

Chemical disinfectants or physical methods

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33
Q

This significantly reduces the microbial load on surfaces

A

Disinfection

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34
Q
A
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35
Q

Detergent or disinfectant: more environmentally friendly, not toxic, produce less odor, and are unlikely to trigger adverse respiratory reactions, a nd cost less

A

Detergent

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36
Q

Detergent or disinfectant: floors cleaned with this do not increase the risk of HAIs, however they do not effectively remove microorganisms

A

Detergents

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37
Q

Recommended for cleaning horizontal surfaces

A

Disinfectants

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38
Q

Detergent or disinfectant: may be used on floors, except critical areas such as isolation rooms, operating rooms, and clean rooms

A

Detergents

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39
Q

Three levels of disinfection

A

Low-level
Intermediate
High-Level

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40
Q

Examples of disinfectants

A

Diluted bleach and hydrogen peroxide solutions

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41
Q

What are the key components of a disinfectant label

A
  • active ingredients
  • EPA registration number
  • Directions for use
  • Contact time
  • Signal words (caution, warning, danger)
    -Precautionary statements (need for PPE)
  • first aid
    -Storage and disposal
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42
Q

What organization registers disinfectants?

A

EPA

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43
Q

The specific time-period that a disinfectant must remain in direct contact with a surface or object to effectively kill or inactivate pathogens, such as bacteria, viruses, and fungi

A

Contact time

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44
Q

Special circumstances when specific disinfectants should be used (examples)

A
  • Blood and body fluids
  • GI pathogens
  • Mycobacterium tb
  • CJD
  • SARS
  • MDROs
  • Rarely encountered unusual pathogens
  • Bed bugs
  • Nurseries
  • Isolation rooms
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45
Q

Considerations when evaluating disinfectants

A

-ease of use
-efficacy
-safety
-cost
- other factors like scent and compatibility

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46
Q

How to evaluate effectiveness of cleaning

A

-Visual inspection
- ATP bioluminescence test
- fluorescent markers
- cultures (though routine cultures are not recommended)

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47
Q

Difference between disinfection and antiseptics

A

Disinfection is only for environmental surfaces, equipment, and objects. Asepsis is for living tissue

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48
Q

Who approves antiseptics?

A

FDA

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49
Q

Example of an antiseptic

A

70-90% isopropyl or ethyl alcohol

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50
Q

Detergents are an example of… cleaner, disinfectant, or antiseptic?

A

Cleaner

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51
Q

Alcohol based hand sanitizers are an example of…cleaner, disinfectant, or antiseptic?

A

Antiseptic

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52
Q

Level of disinfection that destroys all microorganisms except high numbers of bacterial spores

A

High level disinfection

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53
Q

Example of high level disinfection

A

Pasteurization
gluteraldehyde peracetic acid
hydrogen peroxide
chlorine
isopropanol

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54
Q

Level of disinfection that destroys vegetative bacteria, mycobacteria, most viruses, most fungi, but no bacterial spores

A

Intermediate-level disinfection

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55
Q

Example of intermediate level disinfection

A

-EPA registered hospital disinfectant with label claim regarding tb activity
- hydrogen peroxide
-quaternary ammonium compounds

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56
Q

this level of disinfection destroys vegetative bacteria, some fungi and viruses, but not mycobacteria or spores

A

EPA-registered hospital disinfectant with no tb claim (ie chlorine based products, phenolics, improved hp)
- alcohol

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57
Q

What is included in healthcare textiles?

A

Linen
Bedding
Surgical materials

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58
Q

Healthcare textiles- what kind of air pressure is required for soiled areas?

A

Negative air pressure

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59
Q

Healthcare textiles: what signage is required?

A

Warning signs for contaminated textiles

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60
Q

Healthcare textiles: precautions?

A

Standard precautions

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61
Q

Healthcare textiles: rule about shelf liners

A

No cardboard

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62
Q

Healthcare textiles: safety in the workspace

A
  • Hand hygiene resources and safety features
  • clean working surfaces
  • hazardous materials management
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63
Q

What are the 4 parts of the textile processing cycle?

A

1) handling, collection and transport of soiled textiles
2) washing, extraction and drying
3) packaging and storing
4) delivery of cleaned healthcare textiles

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64
Q

Textile processing: Handling, collection, and transportation of soiled textiles: What regulations are in place to protect employees handling soiled textiles

A

OSHA

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65
Q

Textile processing: Handling, collection, and transportation of soiled textiles: What precautions are required for handling soiled textiles

A

Standard precautions

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66
Q

Textile processing: Handling, collection, and transportation of soiled textiles: What is the rule for containing soiled linen

A

Soiled textiles must be securely contained

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67
Q

Textile processing: Handling, collection, and transportation of soiled textiles: Rule for separating healthcare textiles

A

Need to maintain separation of clean and soiled linen throughout the process

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68
Q

Textile processing cycle: Washing, extraction, and drying

A

Establish load sizes for soil classification

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69
Q

Textile processing: washing, extraction and drying: Extraction should minimize ________

A

microbial growth

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70
Q

Textile processing: washing, extraction and drying: temp for drying/ ironing

A

300 F

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71
Q

What are the different cycles of laundry processing?

A

Flush
Main wash
Bleaching
rinsing
Souring

72
Q

Hot water at _____ F for at least _____ minutes destroys microorganisms

A

160
25

73
Q

This chemical agent may be used in laundry processing for germicidal action

A

Chlorine bleach

74
Q

Textile processing cycle: Packaging and storing

A
  • Clean textiles must remain covered
  • storage rooms should have limited access and be clearly labeled
75
Q

textile processing cycle: delivery of cleaned hc textiles

A
  • clean and soiled textiles kept separated
  • transport vehicles must undergo regular cleaning
76
Q

Controversy with home laundering

A
  • OSHA permits scrubs to be laundered at home, agency recommendations differ, but studies show microbial contamination increases with home laundering
77
Q

IP involvement with waste management

A
  • minimized infection risk through education, training, and proper waste handling procedures
  • IPCs advocate for responsible practices and may be involved in investigations related to waste incidents
78
Q

what waste management regulations should the IP understand?

A

local, state, and federal regs

79
Q

what are the infectious waste categories?

A

Contaminated sharps
Microbiology cultures
Animal waste
Blood and blood products
Category A infectious waste
pathology waste

80
Q

What are examples of contaminated sharps?

A

Needles
Scalpels
Broken glass (slides, pasteur pipets)

81
Q

Disposal management of contaminated sharps

A

Rigid, puncture-resistant, closeable and leakproof container for immediate use

82
Q

Example of microbiology cultures (waste management)

A

Bacterial and viral stocks used in research
cultures of infectious agents

83
Q

Disposal management of microbiology cultures

A

Use chemical, autoclave, or irradiation treatment/ inactivation prior to disposal as nonhazardous waste. Ship off-site as regulated medical waste for final disposal if on-site treatment is not possible.

84
Q

Examples of animal waste

A

tissues of blood from research animals infected with infectious agents

85
Q

Disposal management of animal waste

A

Evaluate for potential zoonotic exposure risks. Treat on-site prior to disposal.

86
Q

Examples of blood and blood products

A

Whole blood
Serum
Red blood cells
Albumin
Blood coagulation factors
Immunoglobulin

87
Q

Are small amounts of blood considered regulated medical waste?

A

No

88
Q

Disposal management of blood and blood products

A

Blood saturated materials are to be collected as regulated medical waste.

Use 1:100 diluted bleach or thermal treatment on-site (blood saturated items)

Bulk blood should be solidified if being transported (if not contained so it does not leak and cause a slip)

89
Q

Examples of category A infectious waste

A

Hemorrhagic fever viruses
Hantavirus
Smallpox
Cultures of other agents like Herpes simplex B

90
Q

Disposal management of Category A infectious waste

A

Use on-site autoclave or incineration whenever possible. Off-site treatment requires shipment as a Category A infectious substance and compliance with department of transport recommendations

91
Q

Examples of pathology waste

A

Tissue or organ from autopsy
Tissue collected during surgery

92
Q

Disposal management of pathology waste

A

Formalin fixation
Incineration or grinding of sanitary sewer discharge
Avoid release of recognizable human body parts into landfill waste stream

93
Q

What are the steps for the waste management process?

A

1) generate waste
2) segregate the waste based on classification
3) prepare waste containers for transport (biohazard symbol)
4) treat waste
5) send treated waste to final destination

94
Q

What guidelines can IP use for water management?

A

2003 CDC and HICPAC guidelines
2010 Guidelines for design and construction of HC facilities
APIC construction and reno toolkit

95
Q

Water systems and equipment

A
  • Water distribution systems
  • cooling towers
  • decorative fountains and water walls
  • sinks/ flushing rim sinks, hoppers, toilets
  • Eyewash/ shower stations
  • Ice storage chests and ice machines
  • Water baths and related devices
  • Whirlpools, spas, and tanks
  • Patient care equipment
96
Q

recommendations for water distribution: cold water should be maintained below what temp?

A

68F (20C)

97
Q

Water distribution recommendations: Hot water must be maintained above what temp?

A

140 F(60C)

98
Q

Water distribution recommendations: Minimum return temperature for hot water circulations

A

124F (51C)

99
Q

Water distribution recommendations: what to install to prevent scalding

A

Thermostatic mixing valves

100
Q

These are used in HVAC systems to dissipate excess heat

A

Cooling tower

101
Q

recommendations for cooling towers

A
  • Direct tower drift away from hospital air intake system
  • use approved biocide for maintenance
102
Q

How often should large hydrotherapy pools be drained and thoroughly cleaned?

A

Every 1-2 weeks

103
Q

How often should pools be filtered?

A

At least 3 times a day

104
Q

How often should hubbard and immersion tanks be drained and cleaned?

A

After each patient’s use

105
Q

What is a special recommendation for hydrotherapy tanks in burn units?

A

Use a plastic liner

106
Q

Recommendations for ice storage chests and ice making machines

A

-implement routine cleaning schedule

107
Q

What are the steps to cleaning ice machines?

A

disconnect
discard ice
clean with soap or detergent
rinse with tap
final chlorine solution
Dry before use

108
Q

What are the cleaning recommendations for eye wash stations?

A

Flush weekly for at least 3 minutes

109
Q

Contingency planning for utility disruptions (water)

A
  • water heating and hyperchlorination
  • hand hygiene and env cleaning provisions
  • sterile water for wound irrigation
  • provide patients with alt (bottled water, no rinse cleansing cloths)
  • uphold sterilization protocols for instruments
110
Q

Temperature for heating water after disruption to utility services

A

160-170 F

111
Q

Recommendations for flooding and water leakage

A
  • removal of moisture source
  • cleanup within 24-48 hours
  • disinfection using diluted bleach
  • thorough drying
112
Q

Specialized systems and technology designed to control and maintain the indoor environment of healthcare facilities

A

Heating, ventilation, and air conditioning (HVAC)

113
Q

Components of HVAC

A

temperature
Humidity
Air quality
Airflow

114
Q

What organisms are associated with HVAC systems?

A
  • Aspergillus
  • Saracladium kiliense (fungus)
  • Legionella
  • Airborne infections
115
Q

this organism can result from poor HVAC maintenance

A

Aspergillus

116
Q

Process of raising the temperature within a building or space using various methods to maintain a comfortable and safe environment

A

Heaating

117
Q

The controlled exchange of indoor and outdoor air to maintain adequate air quality

A

Ventilation

118
Q

What components of the HVAC distribute fresh outdoor air and remove indoor air?

A

Fans and ducts

119
Q

The process of cooling and dehumidifying indoor air to maintain a comfortable temperature

A

Air conditioning

120
Q

Component of HVAC that circulates and conditions the air.

A

Air Handler

121
Q

What does the air handler include?

A
  • blower
  • filter
  • sometimes heating and cooling elements
122
Q

Network of pipes or channels that transport conditioned air throughout a building

A

Ductwork

123
Q

Device that controls the HVAC system’s operation based on temperature settings

A

Thermostat

124
Q

The process of regulating the moisture content in indoor air

A

Humidity control system

125
Q

System that divides a building into different zones, each with it’s thermostat and independent control over heating and cooling

A

Zone control

126
Q

The path of air movement within HVAC systems, which can be one-way flow or two-way flow

A

Airflow direction

127
Q

Air that is expelled from a building or room and typically contains contaminants

A

Exhaust air

128
Q

Air that is drawn back into the HVAC system for conditioning and redistribution. It often passes through filters to remove contaminants

A

Return air

129
Q

Process of removing particles, dust, and microorganisms from the air using filters

A

Filtration

130
Q

Fresh air intake should be positioned at least this far away from potential contamination sources (such as exhaust)

A

25 feet

131
Q

Outdoor air intakes should be elevated at least this high above ground

A

6 ft

132
Q

Outdoor air intakes should be elevated at least this high above the roof’s surface

A

3 ft

133
Q

Exhaust outlets service contaminated areas should be positioned here

A

Above roof level

134
Q

In new construction, air supply outlets for critical areas should be strategically place near here, while returns should be closer to the floor

A

Center of the work area

135
Q

how many times the air within an area is replaced in 1 hour, including outside air exchanges to dilute contaminants

A

Air changes per hour (ACH)

136
Q

What is the minimum air changes per hour in high risk settings?

A

> = 12 ACH

137
Q

What is the minimum air changes per hour in registration/ outpatient/ inpatient departments?

A

> =6 ACH

138
Q

examples of high risk settings that require >=12 ACH

A

1) ART centres
2) TB/ Chest departments
3) bronchoscopy procedure rooms
4) MDR-TB wards and clinics
5) Airborne isolation rooms

139
Q

Waste management for HVAC filters

A

Can be disposed of in general waste stream

140
Q

HVAC filter size range

A

0.3-5 microns

141
Q

Describe the filtration system in an HVAC

A

pre-filter before fan (30% efficiency), additional filters after fan with 85-90% efficiency rating. together, 95% efficient at removing particles

142
Q

scale for rating air filters based on their filtration capabilities

A

MERV chart (Minimum Efficiency Reporting Value)

143
Q

range on the MERV scale

A

1-16

144
Q

What do higher MERV rating indicate?

A

Greater filtration efficiency

145
Q

Where should a MERV of 14 or higher be used?

A

Operating rooms

146
Q

Where should HEPA filters be used?

A

Isolation rooms and protective environments

147
Q

In terms of clean and less clean, how should airflow move?

A

Clean to less clean

148
Q

Where is exhaust air typically located?

A

near the floor

149
Q

This type of room pressure is used to prevent microbial contamination from entering the room

A

Positive pressure

150
Q

Who should positive pressure rooms be used for?

A

patients with compromised immune systems

151
Q

Examples of where positive pressure rooms should be located

A

Operating rooms
Special procedure rooms
Protective environments

152
Q

This room pressure is used to contain potentially infectious microbes within a room

A

Negative pressure

153
Q

Who should negative pressure rooms be used for?

A

patients with airborne transmitted diseases

154
Q

Examples of negative pressure rooms

A

Airborne isolation rooms
Toilet rooms
Bronchoscopy rooms
ED waiting rooms

155
Q

Filter required for airborne isolation rooms

A

HEPA

156
Q

How many air exchanges should there be for an airborne isolation room?

A

> =12 ACH

157
Q

How to monitor Airborne isolation rooms

A

-Routine monitoring important
- Use devices that provide visual demonstration of airflow direction
- air monitors

158
Q

Design of airborne isolation room

A

Private room
Tight sealing
no reversible airflow
May have anteroom

159
Q

How does the air move in negative pressure room?

A

Areas of higher air pressure (outside of the room) to areas of lower air pressure (inside of room)

160
Q

Specially designed spaces within hc facilities that play a crucial role in safeguarding highly immunosuppressed patients from risk of infectious complications

A

Protective environments

161
Q

What type of air pressure for a protective environment?

A

Positive pressure

162
Q

Filter required for protective environment

A

HEPA

163
Q

How much % must HEPA filtered air exceed exhaust air by in a protective environment?

A

10%

164
Q

How does air flow in a protective environment?

A

From the patient area toward the corridor

165
Q

How many air exchanges in the protective environment?

A

> =12 ACH

166
Q

Direction of airflow in OR

A

Air supply from ceiling near center of room, down and to the periphery of the room

167
Q

Is high-velocity laminar appropriate for the OR?

A

No, can cause hypothermia

168
Q

What type of airflow should be used in the Or

A

Non-inductional unidirectional infusion

169
Q

What documents offer guidance that addresses strategies for reducing infection risk during construction and renovation in healthcare facilities

A

2006 Facilities Guidelines Institute (FGI)

170
Q

Key element of the FGI guidelines , must be done before commencing any construction or renovation within healthcare

A

ICRA- Infection Control Risk Assessment

171
Q

systematic and thorough evaluation conducted within healthcare facilities to assess and manage the potential risks associated with infections during construction, renovation, or maintenance projects

A

ICRA (Infection control risk assessment)

172
Q

Who should be on the ICRA team?

A

infection control practioners
Facility managers
Engineers
Construction personnel

173
Q

ICRA (Infection control risk assessment) framework

A

1) Early implementation
2) assessment of conditions
3) ID of risks and risk classification
4) Development of mitigation strategies
5) Documentation
6) Communication and collaboration
7) implementation of mitigation strategies
8) monitoring compliance with regs and guidelines

174
Q

Name for the mitigation strategies in ICRA

A

Infection control risk mitigation recommendations

175
Q

Examples of key Infection control risk mitigation recommendations (ICRMR)

A
  • containment barriers (isolate construction zones)
  • Negative pressure ventilation (prevents dust/ pathogens from escaping)
  • HEPA filtration
  • waste disposal protocols
  • proactive water management to avoid legionella/ waterborne diseases
176
Q

Examples of ICRMR

A
  • Patient locations and relocations
  • Containment barriers
  • Monitoring construction phases
  • Training requirements
  • Lav and eating facilities
  • Env surveillance
  • Airflow managemnet
  • Life safety recommendations
  • Dust mitigation
177
Q
A

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