Pa Doh Env Of Care Flashcards
1
Q
All aspects of the healthcare env
A
Environment of care
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
3
Q
Non regulatory agencies involved with the env of care
A
CDC
APIC
AORN
AHE
4
Q
Regulatory agencies involved with the environment of care
A
CMS
OSHA
FDA
TJC
5
Q
____ ensure regulatory compliance in healthcare facilities
A
audits
6
Q
The process of removing visible dirt, organic material, and debris from surfaces and objects
A
Cleaning
7
Q
The process of killing or inactivating microorganisms on surfaces and objects
A
Disinfection
8
Q
Destroys all microorganisms including bacterial spores
A
Sterilization
9
Q
What are the two groups for environmental cleaning?
A
High touch surfaces
Low touch surfaces
10
Q
These require frequent cleaning due to the frequent handling and the risk of infection transmission
A
High-touch surfaces
11
Q
Examples of high-touch surfaces
A
-Medical equipment knobs/ handles
- blood pressure cuffs
- bedrails
- doorknobs
- light switches
12
Q
Examples of low-touch surfaces
A
-floors
-walls
-window curtains
-lights
-ventilation grills
13
Q
What are the two zones related the healthcare?
A
Patient zone
Healthcare zone
14
Q
This healthcare zone includes the patient and their immediate surroundings
A
Patient zone
15
Q
This zone includes all areas outside the patient zone, like a waiting room
A
Healthcare zone
16
Q
All healthcare facilities require cleaning, and all healthcare facilities should have cleaning _______________
A
Policies and procedures
17
Q
Cleaning policies: customization
A
customize to facility’s needs and regulatory compliance
18
Q
Cleaning policies: specifics to address
A
Departmental concerns
specify protocols
list agents and equpment
19
Q
Cleaning policies: schedule
A
Set cleaning schedule and quality control
20
Q
Cleaning policies: collaboration
A
Collaboration between multidisciplinary stakeholders
21
Q
Cleaning policies: guidance
A
Follow guidance from reputable agencies like Association for Healthcare Environment (AHE)
22
Q
Cleaning policies: Implementation
A
Implement systematic cleaning procedures
23
Q
Cleaning procedures: where to clean first
A
Clean from less soiled to more soiled areas and from high to low surfaces
24
Q
Cleaning procedures: when to clean
A
Clean promptly after device/ equipment use
25
Cleaning procedures: separation of items
separate reusable items from disposables
26
cleaning procedures: precautions for handling equipment
Standard precautions
27
cleaning procedures: what to use to clean
Detergents or enzymatic cleaners
28
cleaning procedures: considerations for manual/ automatic
Consider manual instrument, mechanical, or automatic cleaners for safety and efficiency
29
cleaning procedures: order cleaning/ disinfection
Cleaning before disinfection
30
What solutions are typically used for cleaning?
Detergent or cleaning agent and water
31
this reduces the overall microbial load, but may not eliminate all pathogens
Cleaning
32
What solution does disinfection typically use?
Chemical disinfectants or physical methods
33
This significantly reduces the microbial load on surfaces
Disinfection
34
35
Detergent or disinfectant: more environmentally friendly, not toxic, produce less odor, and are unlikely to trigger adverse respiratory reactions, a nd cost less
Detergent
36
Detergent or disinfectant: floors cleaned with this do not increase the risk of HAIs, however they do not effectively remove microorganisms
Detergents
37
Recommended for cleaning horizontal surfaces
Disinfectants
38
Detergent or disinfectant: may be used on floors, except critical areas such as isolation rooms, operating rooms, and clean rooms
Detergents
39
Three levels of disinfection
Low-level
Intermediate
High-Level
40
Examples of disinfectants
Diluted bleach and hydrogen peroxide solutions
41
What are the key components of a disinfectant label
- 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
42
What organization registers disinfectants?
EPA
43
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
Contact time
44
Special circumstances when specific disinfectants should be used (examples)
- Blood and body fluids
- GI pathogens
- Mycobacterium tb
- CJD
- SARS
- MDROs
- Rarely encountered unusual pathogens
- Bed bugs
- Nurseries
- Isolation rooms
45
Considerations when evaluating disinfectants
-ease of use
-efficacy
-safety
-cost
- other factors like scent and compatibility
46
How to evaluate effectiveness of cleaning
-Visual inspection
- ATP bioluminescence test
- fluorescent markers
- cultures (though routine cultures are not recommended)
47
Difference between disinfection and antiseptics
Disinfection is only for environmental surfaces, equipment, and objects. Asepsis is for living tissue
48
Who approves antiseptics?
FDA
49
Example of an antiseptic
70-90% isopropyl or ethyl alcohol
50
Detergents are an example of... cleaner, disinfectant, or antiseptic?
Cleaner
51
Alcohol based hand sanitizers are an example of...cleaner, disinfectant, or antiseptic?
Antiseptic
52
Level of disinfection that destroys all microorganisms except high numbers of bacterial spores
High level disinfection
53
Example of high level disinfection
Pasteurization
gluteraldehyde peracetic acid
hydrogen peroxide
chlorine
isopropanol
54
Level of disinfection that destroys vegetative bacteria, mycobacteria, most viruses, most fungi, but no bacterial spores
Intermediate-level disinfection
55
Example of intermediate level disinfection
-EPA registered hospital disinfectant with label claim regarding tb activity
- hydrogen peroxide
-quaternary ammonium compounds
56
this level of disinfection destroys vegetative bacteria, some fungi and viruses, but not mycobacteria or spores
EPA-registered hospital disinfectant with no tb claim (ie chlorine based products, phenolics, improved hp)
- alcohol
57
What is included in healthcare textiles?
Linen
Bedding
Surgical materials
58
Healthcare textiles- what kind of air pressure is required for soiled areas?
Negative air pressure
59
Healthcare textiles: what signage is required?
Warning signs for contaminated textiles
60
Healthcare textiles: precautions?
Standard precautions
61
Healthcare textiles: rule about shelf liners
No cardboard
62
Healthcare textiles: safety in the workspace
- Hand hygiene resources and safety features
- clean working surfaces
- hazardous materials management
63
What are the 4 parts of the textile processing cycle?
1) handling, collection and transport of soiled textiles
2) washing, extraction and drying
3) packaging and storing
4) delivery of cleaned healthcare textiles
64
Textile processing: Handling, collection, and transportation of soiled textiles: What regulations are in place to protect employees handling soiled textiles
OSHA
65
Textile processing: Handling, collection, and transportation of soiled textiles: What precautions are required for handling soiled textiles
Standard precautions
66
Textile processing: Handling, collection, and transportation of soiled textiles: What is the rule for containing soiled linen
Soiled textiles must be securely contained
67
Textile processing: Handling, collection, and transportation of soiled textiles: Rule for separating healthcare textiles
Need to maintain separation of clean and soiled linen throughout the process
68
Textile processing cycle: Washing, extraction, and drying
Establish load sizes for soil classification
69
Textile processing: washing, extraction and drying: Extraction should minimize ________
microbial growth
70
Textile processing: washing, extraction and drying: temp for drying/ ironing
300 F
71
What are the different cycles of laundry processing?
Flush
Main wash
Bleaching
rinsing
Souring
72
Hot water at _____ F for at least _____ minutes destroys microorganisms
160
25
73
This chemical agent may be used in laundry processing for germicidal action
Chlorine bleach
74
Textile processing cycle: Packaging and storing
- Clean textiles must remain covered
- storage rooms should have limited access and be clearly labeled
75
textile processing cycle: delivery of cleaned hc textiles
- clean and soiled textiles kept separated
- transport vehicles must undergo regular cleaning
76
Controversy with home laundering
- OSHA permits scrubs to be laundered at home, agency recommendations differ, but studies show microbial contamination increases with home laundering
77
IP involvement with waste management
- 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
what waste management regulations should the IP understand?
local, state, and federal regs
79
what are the infectious waste categories?
Contaminated sharps
Microbiology cultures
Animal waste
Blood and blood products
Category A infectious waste
pathology waste
80
What are examples of contaminated sharps?
Needles
Scalpels
Broken glass (slides, pasteur pipets)
81
Disposal management of contaminated sharps
Rigid, puncture-resistant, closeable and leakproof container for immediate use
82
Example of microbiology cultures (waste management)
Bacterial and viral stocks used in research
cultures of infectious agents
83
Disposal management of microbiology cultures
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
Examples of animal waste
tissues of blood from research animals infected with infectious agents
85
Disposal management of animal waste
Evaluate for potential zoonotic exposure risks. Treat on-site prior to disposal.
86
Examples of blood and blood products
Whole blood
Serum
Red blood cells
Albumin
Blood coagulation factors
Immunoglobulin
87
Are small amounts of blood considered regulated medical waste?
No
88
Disposal management of blood and blood products
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
Examples of category A infectious waste
Hemorrhagic fever viruses
Hantavirus
Smallpox
Cultures of other agents like Herpes simplex B
90
Disposal management of Category A infectious waste
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
Examples of pathology waste
Tissue or organ from autopsy
Tissue collected during surgery
92
Disposal management of pathology waste
Formalin fixation
Incineration or grinding of sanitary sewer discharge
Avoid release of recognizable human body parts into landfill waste stream
93
What are the steps for the waste management process?
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
What guidelines can IP use for water management?
2003 CDC and HICPAC guidelines
2010 Guidelines for design and construction of HC facilities
APIC construction and reno toolkit
95
Water systems and equipment
- 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
recommendations for water distribution: cold water should be maintained below what temp?
68F (20C)
97
Water distribution recommendations: Hot water must be maintained above what temp?
140 F(60C)
98
Water distribution recommendations: Minimum return temperature for hot water circulations
124F (51C)
99
Water distribution recommendations: what to install to prevent scalding
Thermostatic mixing valves
100
These are used in HVAC systems to dissipate excess heat
Cooling tower
101
recommendations for cooling towers
- Direct tower drift away from hospital air intake system
- use approved biocide for maintenance
102
How often should large hydrotherapy pools be drained and thoroughly cleaned?
Every 1-2 weeks
103
How often should pools be filtered?
At least 3 times a day
104
How often should hubbard and immersion tanks be drained and cleaned?
After each patient's use
105
What is a special recommendation for hydrotherapy tanks in burn units?
Use a plastic liner
106
Recommendations for ice storage chests and ice making machines
-implement routine cleaning schedule
107
What are the steps to cleaning ice machines?
disconnect
discard ice
clean with soap or detergent
rinse with tap
final chlorine solution
Dry before use
108
What are the cleaning recommendations for eye wash stations?
Flush weekly for at least 3 minutes
109
Contingency planning for utility disruptions (water)
- 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
Temperature for heating water after disruption to utility services
160-170 F
111
Recommendations for flooding and water leakage
- removal of moisture source
- cleanup within 24-48 hours
- disinfection using diluted bleach
- thorough drying
112
Specialized systems and technology designed to control and maintain the indoor environment of healthcare facilities
Heating, ventilation, and air conditioning (HVAC)
113
Components of HVAC
temperature
Humidity
Air quality
Airflow
114
What organisms are associated with HVAC systems?
- Aspergillus
- Saracladium kiliense (fungus)
- Legionella
- Airborne infections
115
this organism can result from poor HVAC maintenance
Aspergillus
116
Process of raising the temperature within a building or space using various methods to maintain a comfortable and safe environment
Heaating
117
The controlled exchange of indoor and outdoor air to maintain adequate air quality
Ventilation
118
What components of the HVAC distribute fresh outdoor air and remove indoor air?
Fans and ducts
119
The process of cooling and dehumidifying indoor air to maintain a comfortable temperature
Air conditioning
120
Component of HVAC that circulates and conditions the air.
Air Handler
121
What does the air handler include?
- blower
- filter
- sometimes heating and cooling elements
122
Network of pipes or channels that transport conditioned air throughout a building
Ductwork
123
Device that controls the HVAC system's operation based on temperature settings
Thermostat
124
The process of regulating the moisture content in indoor air
Humidity control system
125
System that divides a building into different zones, each with it's thermostat and independent control over heating and cooling
Zone control
126
The path of air movement within HVAC systems, which can be one-way flow or two-way flow
Airflow direction
127
Air that is expelled from a building or room and typically contains contaminants
Exhaust air
128
Air that is drawn back into the HVAC system for conditioning and redistribution. It often passes through filters to remove contaminants
Return air
129
Process of removing particles, dust, and microorganisms from the air using filters
Filtration
130
Fresh air intake should be positioned at least this far away from potential contamination sources (such as exhaust)
25 feet
131
Outdoor air intakes should be elevated at least this high above ground
6 ft
132
Outdoor air intakes should be elevated at least this high above the roof's surface
3 ft
133
Exhaust outlets service contaminated areas should be positioned here
Above roof level
134
In new construction, air supply outlets for critical areas should be strategically place near here, while returns should be closer to the floor
Center of the work area
135
how many times the air within an area is replaced in 1 hour, including outside air exchanges to dilute contaminants
Air changes per hour (ACH)
136
What is the minimum air changes per hour in high risk settings?
>= 12 ACH
137
What is the minimum air changes per hour in registration/ outpatient/ inpatient departments?
>=6 ACH
138
examples of high risk settings that require >=12 ACH
1) ART centres
2) TB/ Chest departments
3) bronchoscopy procedure rooms
4) MDR-TB wards and clinics
5) Airborne isolation rooms
139
Waste management for HVAC filters
Can be disposed of in general waste stream
140
HVAC filter size range
0.3-5 microns
141
Describe the filtration system in an HVAC
pre-filter before fan (30% efficiency), additional filters after fan with 85-90% efficiency rating. together, 95% efficient at removing particles
142
scale for rating air filters based on their filtration capabilities
MERV chart (Minimum Efficiency Reporting Value)
143
range on the MERV scale
1-16
144
What do higher MERV rating indicate?
Greater filtration efficiency
145
Where should a MERV of 14 or higher be used?
Operating rooms
146
Where should HEPA filters be used?
Isolation rooms and protective environments
147
In terms of clean and less clean, how should airflow move?
Clean to less clean
148
Where is exhaust air typically located?
near the floor
149
This type of room pressure is used to prevent microbial contamination from entering the room
Positive pressure
150
Who should positive pressure rooms be used for?
patients with compromised immune systems
151
Examples of where positive pressure rooms should be located
Operating rooms
Special procedure rooms
Protective environments
152
This room pressure is used to contain potentially infectious microbes within a room
Negative pressure
153
Who should negative pressure rooms be used for?
patients with airborne transmitted diseases
154
Examples of negative pressure rooms
Airborne isolation rooms
Toilet rooms
Bronchoscopy rooms
ED waiting rooms
155
Filter required for airborne isolation rooms
HEPA
156
How many air exchanges should there be for an airborne isolation room?
>=12 ACH
157
How to monitor Airborne isolation rooms
-Routine monitoring important
- Use devices that provide visual demonstration of airflow direction
- air monitors
158
Design of airborne isolation room
Private room
Tight sealing
no reversible airflow
May have anteroom
159
How does the air move in negative pressure room?
Areas of higher air pressure (outside of the room) to areas of lower air pressure (inside of room)
160
Specially designed spaces within hc facilities that play a crucial role in safeguarding highly immunosuppressed patients from risk of infectious complications
Protective environments
161
What type of air pressure for a protective environment?
Positive pressure
162
Filter required for protective environment
HEPA
163
How much % must HEPA filtered air exceed exhaust air by in a protective environment?
10%
164
How does air flow in a protective environment?
From the patient area toward the corridor
165
How many air exchanges in the protective environment?
>=12 ACH
166
Direction of airflow in OR
Air supply from ceiling near center of room, down and to the periphery of the room
167
Is high-velocity laminar appropriate for the OR?
No, can cause hypothermia
168
What type of airflow should be used in the Or
Non-inductional unidirectional infusion
169
What documents offer guidance that addresses strategies for reducing infection risk during construction and renovation in healthcare facilities
2006 Facilities Guidelines Institute (FGI)
170
Key element of the FGI guidelines , must be done before commencing any construction or renovation within healthcare
ICRA- Infection Control Risk Assessment
171
systematic and thorough evaluation conducted within healthcare facilities to assess and manage the potential risks associated with infections during construction, renovation, or maintenance projects
ICRA (Infection control risk assessment)
172
Who should be on the ICRA team?
infection control practioners
Facility managers
Engineers
Construction personnel
173
ICRA (Infection control risk assessment) framework
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
Name for the mitigation strategies in ICRA
Infection control risk mitigation recommendations
175
Examples of key Infection control risk mitigation recommendations (ICRMR)
- 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
Examples of ICRMR
- 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
