Patient Safety: Handwashing, Sterilization, and Isolation

Question 1

healthcare-associated infections are the ______________leading cause of death in the US behind heart disease, cancer, and strokes.

Answer 1

4th

Question 2

75% of all hospitals have been cited for serious ____________________________.

Answer 2

cleanliness and sanitation violations

Question 3

why should we care about healthcare-associated infections (HAI’s)?

Answer 3

they are a major threat to patient safety

Question 4

Central line-associated bloodstream infections (CLABSI)

Answer 4

ICUs, NICUs, and wards

Question 5

Catheter-associated urinary tract infections (CAUTI)

Answer 5

ICUs and wards

Question 6

C. difficile infections

Answer 6

all inpatient locations in the facility, with the exception of the NICU and well-baby locations

Question 7

surgical site infections

Answer 7

colorectal, hysterectomy

Question 8

MRSA bloodstream infections

Answer 8

all inpatient locations in the facility

Question 9

approximate sources of hospital-onset infections:

Answer 9

-patient’s endogenous flora, 40-60%
-cross-infection via hands of personnel, 20-40%
-antibiotic-driven changes in flora, 20-25%
-other, 20%

Question 10

what are the steps to properly wash hands?

Answer 10

1. wet hands with clean water, turn off tap, apply soap
2. rub hands together with soap, lather back of hand, between fingers and under nails
3. scrub for at least 20 seconds
4. rinse your hands
5. dry your hands

Question 11

if you don’t have access to soap and water, use

Answer 11

-hospital-grade foam
-hand sanitizer with > 60% ethanol content

Question 12

when is alcohol-based sanitizer the preferred method for cleaning hands in a healthcare setting?

Answer 12

when they are not visibly dirty

Question 13

what should be used to clean your hands from spores or certain viruses like C. diff or Norovirus?

Answer 13

soap and water

Question 14

when should hand hygiene be performed for all employees?

Answer 14

-upon entry of patient room or care area even when not touching the patient
-before applying gloves and after removing gloves
-before and after patient contact

Question 15

sterilization

Answer 15

-complete destruction of all forms of life
-includes bacteria, spores, fungi, and viruses
-no such thing as partially sterile

Question 16

disinfection

Answer 16

-use of agent to lower the number of growing microorganisms
-does not provide sterility (some may survive)

Question 17

disinfectant

Answer 17

-agent which lowers the count of viable organisms
-usually applied to inanimate objects

Question 18

antiseptic

Answer 18

-an agent which lowers the count of viable microorganisms
-usually applied to patients

Question 19

-penetrate soft tissue or contact bone, enter into or contact the vascular system or other normally sterile tissue
-greatest risk of transmitting infection
-must be heat sterilized or disposable
-ex. surgical instruments

Answer 19

critical items

Question 20

-contact mucous membranes or non-intact skin
-lower risk of transmission
-should be heat sterilized or high-level disinfected
-ex. mouth mirrors, amalgam condensers, reusable impression trays

Answer 20

semicritical items

Question 21

-contact intact skin
-barrier protect or clean and disinfect
-ex. blood pressure cuff

Answer 21

noncritical items

Question 22

agents which inhibit the growth of microorganisms; upon removal of the agent, growth may resume

Answer 22

bacteriostatic

Question 23

agents which kill microorganisms; upon removal of agent, growth cannot resume

Answer 23

bactericidal

Question 24

the irreversible inability of a microorganism to reproduce

Answer 24

microbial death

Question 25

what is the level of microbial resistance to germicidal chemicals from most resistant to least resistant?

Answer 25

1. bacterial spores (bacillus & clostridium) 2. mycobacteria (mycobacterium tuberculosis) 3. non-enveloped viruses (poliovirus & coxsackievirus) 4. fungi (aspergillus & candida) 5. vegetative bacteria (pseudomonas aeruginosa, staphylococcus aureus, and E. coli) 6. enveloped viruses (herpes, HIV)

Question 26

what are the factors that affect potency of chemical agents

Answer 26

-number and location of microorganisms -innate resistance of microorganisms -presence of extraneous materials -concentration of the agent -time -temp, pH

Question 27

what chemical agents target membrane function?

Answer 27

-quaternary ammonium compounds -detergents -phenols -organic solvents -alcohols

Question 28

what chemical agents can denature proteins?

Answer 28

-acids and alkalis -phenols -acetone and other organic solvents -alcohols

Question 29

what chemical agents destroy or modify the functional groups of proteins?

Answer 29

-heavy metals -oxidizing agents -dyes -alkylating agents

Question 30

how does hand sanitizer serve as a chemical agent?

Answer 30

alcohols make cytoplasmic membranes more permeable which allows leakage of cell contents, and denaturation of proteins

Question 31

what are some high activity disinfectants and what are they active against?

Answer 31

-formaldehyde -glutaraldehyde -gaseous ethylene oxide bacterial spores, mycobacteria, nonenveloped viruses, vegetative bacteria, enveloped viruses

Question 32

what are some intermediate activity disinfectants and what are they active against?

Answer 32

-phenols -chlorine -iodophores -alcohols -mycobacteria, vegetative bacteria, enveloped viruses

Question 33

what are some low activity disinfectants and what are they active against?

Answer 33

-detergents -quaternary ammonium compounds -mercurials -vegetative bacteria

Question 34

what are the properties of an ideal disinfectant?

Answer 34

-broad spectrum -fast-acting -not affected by physical factors -non-toxic -surface compatibility -residual effect on treated surfaces -easy to use -odorless -economical

Question 35

sterilant activity against mycobacterium bovis:

Answer 35

-1.5% glutaraldehyde (28-36 minutes) -2.5% glutaraldehyde (14-18 minutes) -0.21% OPA (4.8-6.3 minutes)

Question 36

what are disinfectants you might encounter in the clinic?

Answer 36

-OPA -Triclosan -chlorhexidine -unsaturated chemical vapor -ethylene oxide -chlorine dioxide -hydrogen peroxide gas plasma

Question 37

ortho-phthalaldehyde (OPA)

Answer 37

-requires no activation -not known to irritate the eyes or nose -stable over a wide pH range -does not require exposure monitoring -barely perceptible odor

Question 38

Triclosan

Answer 38

-bacteriostatic activity against gram-negatives and gram-positives -increasingly found in persona care and consumer products

Question 39

chlorhexidine

Answer 39

-chlorhexidine gluconate (oral rinse) -antiseptic with antibacterial and some antiviral activity -effective agent for the prevention and treatment of oral disease -absorbs to negatively charged surfaces in the mouth (prolonged antimicrobial activity)

Question 40

unsaturated chemical vapor

Answer 40

-involves heating a chemical solution, typically alcohol with 0.23% formaldehyde, in a closed pressurized chamber -131 C, 20 psi, 30 mins

Question 41

what are the advantages and disadvantages of unsaturated chemical vapor?

Answer 41

-advantages: short cycle time, does not dull cutting edges, rust or corrode -disadvantages: instruments must be completely dried, may destroy heat-sensitive materials, chemical odor in poorly ventilated areas

Question 42

what is the temp and cycle time for ethylene oxide?

Answer 42

room temp and 10-16 hours

Question 43

advantages and disadvantages of ethylene oxide?

Answer 43

-advantages: high capacity for penetration, does not damage heat-labile materials, evaporates without leaving a residue, suitable for materials that cannot be exposed to moisture -disadvantages: slow, retained in liquids and rubber material for prolonged intervals, causes tissue irritation if not well aerated, requires special spark-shield for explosion potential

Question 44

chlorine dioxide

Answer 44

-relatively new sterilization agent -not yet routinely used but may replace ethylene oxide or chemical vapor -has been used to sterilize entire buildings contaminated with anthrax spores -will inactivate prions

Question 45

hydrogen peroxide gas plasma

Answer 45

-h2o2 vapor subjected to electrical field -widely used for surgical -relatively free of toxic residuals, compatible with many medical device materials -used to disinfect hospitals undergoing outbreaks of carbapenem-resistant Klebsiella pneumoniae -widely used for sterilizing re-usable PPE during covid

Question 46

what are the physical agents used to disinfect

Answer 46

-heat -radiation -filtration -ultrasound -freezing

Question 47

steam autoclave settings

Answer 47

-121 C, 15 psi, 15-20min -134 C, 30 psi, 4-5 min

Question 48

advantages and disadvantages of autoclaving

Answer 48

-advantages: short cycle time, good penetration, wide range of materials can be processed without destruction -disadvantages: corrosion of unprotected carbon steel instruments, dulling of unprotected cutting edges, packages may remain wet at end of cycle, may destroy heat sensitive materials, effectiveness reduced if chamber is overloaded due to reduced steam penetration

Question 49

dry heat temp and cycle time

Answer 49

-160 C, 2 hours -170 C, 1 hour

Question 50

advantages and disadvantages of dry heat

Answer 50

-advantages: effective and safe for sterilization of metal instruments, powders oils; does not dull cutting edges, rust or corrode -disadvantages: long cycle required for sterilization, poor penetration, may discolor and char fabric, destroys heat-labile items

Question 51

radiation

Answer 51

-causes single or double strand breaks in nucleic acids and free radicals -some agents are resistant (spores and prions) -UV light used as municipal water disinfectant -gamma rays used in industry

Question 52

explain the relationship between radiation and water

Answer 52

-cells are mostly water -radiation on water releases electrons and free radicals that then damage other molecules in the cell

Question 53

what are the 4 ways that we can monitor sterilization

Answer 53

-concentration test strips -process indicators -dosage indicators -biologic indicators

Question 54

process indicators

Answer 54

-dye changes according to temperature -does not inform on the whole process, no guarantee of sterility -"was the process hot enough?"

Question 55

dosage indicators

Answer 55

-dye changes according to temp and time of exposure

Question 56

biologic indicators

Answer 56

-bacillus spores autoclaved then incubated -dead spores will not germinate, media stays same color -live spores will germinate, change media to yellow

Question 57

common factors in the improper use of sterilizers

Answer 57

-chamber overload -low temp setting -inadequate exposure time -failure to preheat sterilizer -interruption of the cycle

Question 58

cleaning

Answer 58

-should always be done before disinfection or sterilization -automated or manual -minimize exposure potential -use carrying container to transport contaminated instruments -wear personal protective equipment

Question 59

liquid sterilants/disinfectants

Answer 59

-only for heat-sensitive critical and semicritical devices -highly toxic -heat-tolerant or disposable alternatives are generally available

Question 60

in what type of package does a chemical indicator need to be seen or labeled on package

Answer 60

heat treatment