Preventing/Controlling the Transmission of Infectious Agents Flashcards
A woman in active labor with confirmed influenza has been
admitted to an acute care facility. Recommendations for
preventing influenza transmission between hospitalized infected
mothers and their infants include:
1) Keep the isolette at least 3 feet away from the mother when
she is not interacting with the baby
2) Temporarily separate the mother from her baby following
delivery during the hospital stay
3) All feedings should be provided by a healthy caregiver
if possible
4) The baby should receive formula during the 5-day period
following the mother’s symptom onset
a. 1, 2
b. 2, 3
c. 3, 4
d. 1, 4
B 2, 3
Rationale: Pregnant women and infants are at increased risk of hospitalization
from influenza complications. Although it is well-recognized that the ideal
setting for care of a healthy-term newborn while in the hospital is within
the mother’s room, newborns that become infected with influenza are at
increased risk for severe complications. To reduce the risk of influenza in
the newborn, CDC recommends that facilities consider temporarily separating
the mother who is ill with suspected or confirmed influenza from her baby
following delivery during the hospital stay. Throughout the course
of temporary separation, all feedings should be provided by a healthy
caregiver if possible. Mothers who intend to breastfeed should be encouraged
to express their milk.
Most healthcare-associated pathogens are transmitted from
patient to patient via:
a. Improper isolation practices
b. Inadequate sterilization of medical instruments
c. Hands of healthcare personnel
d. Ineffective disinfection of medical devices
C Hands of healthcare personnel
Rationale: According to literature, most healthcare-associated pathogens
are transmitted from patient to patient via the hands of healthcare personnel.
Hand hygiene, therefore, is the simplest and most effective, proven method
to reduce the incidence of HAIs.
A patient is admitted with pruritic lesions on the hands, webs of
fingers, wrists, extensor surfaces of elbows and knees, and the
outer surfaces of the feet, armpits, buttocks, and waist. What
type of isolation does this person require?
a. Contact
b. Droplet
c. Airborne
d. No isolation required
A Contact
Rationale: Skin infestation by the mite Sarcoptes scabiei var. hominis is
commonly known as scabies. Mites are transmitted through direct contact
with infested persons; less frequently, transmission may occur through contact
with clothing or bedding (fomites). Spread of the mite to a different part of
the body can occur by manual transfer or scratching. Because of the high risk
of transmission, the diagnosis of scabies should be considered in any patient
with a pruritic cutaneous eruption, especially those involving the hands, wrist,
and elbows. Patients in a hospital or other healthcare facility should be placed
in Contact Precautions until 24 hours after treatment
An autopsy is ordered on a patient who was diagnosed with
tuberculosis (TB). Which of the following statements is correct
regarding postmortem care of a deceased TB patient?
a. Autopsy rooms should be at positive pressure with
respect to adjacent areas, and room air must be
exhausted directly outside
b. An oscillating autopsy saw should be used to reduce
the infectious aerosols
c. An approved mask is necessary for respiratory protection
d. Standard Precautions are sufficient because Mycobacterium
tuberculosis needs a living host to survive
C An approved mask is necessary for respiratory protection
Rationale: OSHA classifies performance of an autopsy on a known or
suspected case of TB to be a high-hazard procedure requiring personnel to
use approved respiratory protection. In areas where TB is prevalent and the
health history is unknown, respiratory protection is prudent, especially for
medical examiner’s cases
Which of the following patients is not at high risk for a healthcareassociated
fungal infection?
a. Burn patient
b. Premature baby in the Neonatal Intensive Care Unit
c. Bone marrow transplant patient
d. Patient who underwent joint replacement surgery
D Patient who underwent joint replacement surgery
Rationale: Fungi are increasingly being identified as healthcare-associated
pathogens. Patients at high risk for healthcare-associated fungal infections
include patients with leukemia, patients with solid tumors and leukopenia,
bone marrow transplant patients, injection drug users, patients who have
undergone intra-abdominal or cardiothoracic surgery, burn victims, and
premature or low birth weight infants.
The infection preventionist (IP) receives a call from a nurse who is
scheduling a patient for surgery at her ambulatory surgery center.
The nurse tells the IP that the patient is colonized with methicillinresistant
Staphylococcus aureus (MRSA). Which of the following
best describes colonization?
a. The presentation of clinical signs of illness or inflammation
b. An acute bacterial disease caused by an obligate anaerobic,
non–spore-forming rod
c. The permanent presence of bacteria that is part of the
normal flora
d. The presence of microorganisms without the signs/
symptoms of an infection
D The presence of microorganisms without the signs/symptoms
of an infection
Rationale: The term colonization generally denotes the presence of a
microorganism in the absence of symptoms or deep tissue invasion.
Colonizing organisms (e.g., N. gonorrhoeae colonization of pharynx,
Salmonella spp. colonization of stool, MRSA colonization of the nares, and
yeast in the genital tract) may facilitate transmission to others or may lead to
disease in the colonized individual during a disruptive situation (e.g., normal
flora out of balance from antimicrobial treatment, invasive device, or wound).
What type of respiratory protection (mask) is recommended for
immune and nonimmune healthcare personnel when caring for a
patient with smallpox?
a. Surgical mask
b. Exam mask
c. N95 or higher level respirator
d. Procedure mask
C N95 or higher level respirator
Rationale: Smallpox is a disease caused by variola viruses, members of the
Orthopoxvirus genus. Smallpox was eradicated in the 1970s as the result of a
massive worldwide immunization program. Because smallpox does not have
an animal reservoir and has been eradicated from the human population,
the only way that smallpox can occur is as a result of intentional exposure
from a bioterrorism attack. A single confirmed case of smallpox would be a
global health emergency. Routine smallpox vaccination ended in the early
1970s when smallpox was eradicated; thus, approximately 42 percent of the
U.S. population has never been vaccinated against it. The length of immunity
is unclear; residual immunity varies from person to person, but smallpox
immunity is estimated to only last approximately 3 to 5 years for most people
(range 1 to 10 years). Revaccinees (those who have been vaccinated in the
past and receive a booster) are much more likely to have a sustained immune
response than primary vaccinees (those who are receiving the vaccine for
the first time). Survivors of the disease achieve lifelong immunity to smallpox.
Smallpox may be spread person to person via droplets, aerosol, or even
through hand-to-hand contact. Hospitalized patients need to be isolated using
Airborne and Contact Precautions. Airborne Precautions require healthcare
providers and others to do the following: (1) place patient in a private room
with monitored negative pressure in relation to surrounding areas, (2) wear
respiratory protection (N95 respirator) when entering the patient room,
and (3) limit the transport of the patient from the room, and if movement
is absolutely necessary, place a surgical mask on the patient, if possible. In
addition to wearing gloves and gown as outlined in Standard Precautions,
Contact Precautions also require the following: (1) wear gloves when entering
the room, (2) remove gloves before leaving the patient’s room, and (3) wash
hands immediately with an antimicrobial agent or a waterless antiseptic
agent. In addition, wear a gown when entering the room and remove the
gown before leaving the patient’s environment. Dedicate the use of noncritical
patient care equipment to a single patient (or cohort of patients), if possibl
An outbreak of aspergillosis is suspected after several oncology
patients are identified with positive cultures. The IP suspects a
heating, ventilation, and air conditioning (HVAC) malfunction and
begins an outbreak investigation. The IP has been asked to make
recommendations for environmental cultures. All of the following
needs to be considered except:
a. Identifying the purpose of culturing and appropriate
methods beforehand
b. Meeting with the facility legal staff to discuss notification
of the patients
c. Anticipating decisions and planned actions to results of
culturing before undertaking the process
d. Determining whether there are existing standards to
interpret results
B Meeting with the facility legal staff to discuss notification
of the patients
Rationale: When an outbreak is identified or suspected, an environmental
source may be present, and confirmatory testing is appropriate. A critical
review of the indications for airborne particulate monitoring or cultures must
be done in light of basic principles of outbreak investigation (e.g., establishing
that an outbreak exists). One may also consider the following guidance:
• Purpose of culturing and appropriate methods should be identified
beforehand.
• Decisions and planned actions regarding results of culturing should
be anticipated before undertaking the process.
• Determination should be made whether there are existing standards
to interpret results
The U.S. Phamacopoeia (USP) recommends that multidose vials be disposed of: a. 14 days after opening b. 30 days after opening c. 28 days after opening d. When all the medication has been used
C 28 days after opening
Rationale: A multidose vial is a vial of liquid medication intended for
parenteral administration (injection or infusion) that contains more than one
dose of medication. Multidose vials are labeled as such by the manufacturer
and typically contain an antimicrobial preservative to help prevent the growth
of bacteria. The preservative has no effect on viruses and does not protect
against contamination when healthcare personnel fail to follow safe injection
practices. USP Standard <797> requires that a multidose vial be discarded
within 28 days after its first opening in accordance with USP Chapter <51>
unless specified by the manufacturer. The CDC recommends refrigerating
the vials after opening if recommended by the manufacturer, cleaning the
rubber diaphragm of the vial with alcohol before inserting a device into the
vial, using a sterile device each time a vial is accessed, and avoiding touch
contamination of the device before penetrating the rubber diaphragm. The
multidose vial should be discarded when empty, when suspected or visible
contamination occurs, or when the manufacturer’s stated expiration date is
reached. Medications packaged as multidose should be assigned to a single
patient whenever possible.
The policy for therapy animals in healthcare facilities should
include all of the following except:
a. Hand hygiene must be performed after contact with
the animal
b. Animal must be bathed within 24 hours prior to visiting
the healthcare facility
c. Animals must be healthy and current with immunizations
d. Small animals are never allowed to sit on a patient’s bed
D Small animals are never allowed to sit on a patient’s bed
Rationale: Healthcare facilities should develop and implement infection
prevention guidelines and develop policies to minimize the potential risks
associated with having animals in healthcare facilities. These should require
that animals be of good temperament, well-groomed, and healthy and that
that their handlers be educated on infection prevention practices, including
hand hygiene. The following infection prevention and safety guidelines
should be in place:
• The healthcare facility develops policies and guidelines for the safety of
the patients and animals involved in visitation, animal-assisted activities,
and animal-assisted therapy. The healthcare facility should designate a
person or persons to implement the policies, coordinate animal–human
interactions, and act as a liaison to the animal handlers visiting the facility.
• Participating animals must have a temperament test (behavioral
assessment) by an experienced person or recognized group.
• Animals may wear a shirt, vest, or other protective clothing to
control allergies. Wiping the animal with a baby or pet wipe will
help control dandruff.
• Animals must have clean ears.
• Animals must have nails that are short with no rough edges. Animals must
be trained not to scratch the patient. For additional protection, animals
may wear protective foot coverings.
• Animals must be healthy and current with immunizations, including
rabies vaccination and others required in the state in which the
healthcare facility is located. An annual physical examination by a
licensed veterinarian should include dental and dermatological
evaluation. Animals should be free of communicable diseases and
parasites and be on a flea control program.
• Animals must be free of any skin condition or wounds.
• Handlers must ensure that animals do not lick or come in contact with
a patient’s open wound or devices.
• If an animal is allowed on a patient’s bed, a barrier such as a
disposable cloth, towel, or sheet can be placed between the animal’s
coat and the patient’s linen. The barrier is removed and discarded
when the animal leaves.
• Animals are kept on a short leash or in a carrier or basket. The use
of retractable leashes is discouraged.
• The animal’s handler/volunteer must be healthy and free of
communicable diseases. The facility is strongly encouraged to consider
a recommendation to handlers that they receive annual influenza
shots and may be able to offer the vaccine to handlers for free as part
of the annual flu vaccination program
An IP has been asked to provide infection prevention consultation NOTES
to a long-term care facility (LTCF). As a part of this consultation,
she checks to make sure which of the following program
components are in place:
1) Decolonizing residents with MRSA
2) Establishing an antimicrobial stewardship program
3) Implementing an annual influenza vaccination program
4) Collecting environmental cultures of high-touch areas
a. 1, 2
b. 2, 3
c. 3, 4
d. 1, 4
B 2, 3
Rationale: Antibiotic resistance continues to pose a significant problem
for residents in LTCFs because of the overuse and misuse of antibiotics.
Antimicrobial stewardship refers to coordinated interventions designed to
improve and measure the appropriate use of antimicrobials by promoting
the selection of the optimal antimicrobial drug regimen, dose, duration of
therapy, and route of administration. The Infectious Diseases Society of
America and the Society for Healthcare Epidemiology of America support
broad implementation of antimicrobial stewardship programs across all
healthcare settings including LTCFs. In addition, it is recommended that
influenza vaccination be provided to all residents of LTCFs. Influenza
outbreaks in LTCFs may have severe and even deadly consequences for
residents. Because influenza is easily transmitted, it is important that influenza
vaccination is offered to all residents to provide both individual protection
and “herd immunity” (i.e., group protection) in the LTCF. Research has shown
the effectiveness of influenza immunization programs among the geriatric
population and long-term care resident
A hospital is beginning a major construction project. The IP
has been asked to join the planning team to assist with the
development of the Infection Control Risk Assessment (IRCA)
for the project. What is the purpose of the ICRA?
a. Develop and oversee the construction project schedule
b. Minimize infectious hazards for patients and
healthcare personnel
c. Provide direction for level three and four projects only
d. Coordinate systems start-ups
B Minimize infectious hazards for patients and healthcare personnel
Rationale: An IRCA must guide a strategic, proactive design to mitigate
environmental sources of microbes, prevent infectious hazards through
architectural design (e.g., hand washing and hand hygiene stations; isolation
rooms; materials selection for surfaces and furnishings), and provide control
measures that mitigate potential contamination during actual construction or
renovation (e.g., dust barriers, pressure differentials, protection of air handlers).
An “antibiotic time out” occurs:
a. Daily
b. Weekly
c. Within 24 to 48 hours of culture results being available
d. Within 96 hours of culture results being available
C Within 24 to 48 hours of culture results being available
Rationale: Much of antimicrobial prescribing is unnecessary or inappropriate.
The CDC has advocated implementing taking an “antibiotic time out” (ATO)
whereby prescribing clinicians formally assess three pieces of essential
information during clinical rounds: correct dosing, duration of therapy, and
indication for treatment. An ATO should be taken when culture results are
available, usually within 24 to 48 hours.
Of the following methods of disinfection and sterilization, which will kill all organisms, including all bacterial spores? 1) Pasteurization 2) Ortho-phthalaldehyde 3) Steam sterilization 4) Ethylene oxide a. 1, 2 b. 2, 3 c. 1, 3 d. 3, 4
D 3, 4
Rationale: Both steam sterilization and ethylene oxide gas sterilization will kill
bacterial spores and all other microorganisms. Steam sterilization can only be
used for items that are tolerant of high temperatures, such as metal surgical
tools. Ethylene oxide gas sterilization is a low-heat method for items that are
not heat tolerant. Items that are sterilized by ethylene oxide must be allowed
time for aeration before use.
Hydrogen peroxide vapor (HPV) has been shown to be effective
for decontamination of patient rooms and is known to kill
spores and other microbes. Despite its benefits, there are some
drawbacks to using HPV. Which of the following could be a
major drawback to using HPV to clean patient rooms?
a. It is effective in decontaminating surfaces but
not equipment
b. It leaves a residue that, over time, can damage equipment
in the room
c. It lengthens room turnover because it takes a prolonged
period of time to complete room treatment
d. It is most effective for areas closer to the unit and less
effective around the edges of the room
C It lengthens room turnover because it takes a prolonged period
of time to complete room treatment
Rationale: The use of HPV has been shown to decrease the incidence of C.
difficile infection, and it is effective on surfaces and equipment throughout
the room. Drawbacks of this method are that it cannot be utilized while the
patient is in the room and that the process lasts a prolonged period of time.
Because of these issues, it can be challenging to use for daily cleaning, and it
may delay room turnover compared to traditional terminal cleaning methods.
While making rounds in one of the Intensive Care Units, the
IP observes a patient who has just been intubated and is on a
ventilator. He notes that the patient is in a supine position.
Which of the following positions should he recommend to
the nurse in order to be compliant with a pneumonia
prevention bundle?
a. The patient should be turned to his side to facilitate
drainage of secretions
b. The patient should be placed in reverse Trendelenburg
position
c. The patient’s head of the bed should be elevated to an
angle of 30 to 45 degrees
d. The patient should sit upright at a 60 to 75 degree angle
C The patient’s head of the bed should be elevated to an angle
of 30 to 45 degrees
Rationale: There are five components of care to prevent VAP:
1. Elevation of the head of the bed
2. Daily sedative interruption and assessment of readiness to extubate
3. Peptic ulcer disease prophylaxis
4. Deep vein thrombosis prophylaxis
5. Daily oral care with chlorhexidine
A patient with bacterial meningitis due to Neisseria meningitidis
requires what type of Transmission-based Precautions?
a. Contact Precautions
b. Standard Precautions
c. Droplet Precautions
d. Airborne Precautions
C Droplet Precautions NOTES
Rationale: N. meningitidis is an aerobic, Gram-negative diplococcus that
colonizes the nasopharynx of many healthy individuals. Microbial and host
factors combine to allow this organism to invade the bloodstream and
enter the central nervous system, causing severe sepsis and meningitis.
Hypervirulent strains may be transmitted from person to person through
respiratory secretions, causing outbreaks of meningococcal disease. Rapid
identification of the pathogen, institution of Droplet Precautions based
on suspicion of meningococcal disease, initiation of appropriate antibiotic
therapy, and administration of chemoprophylaxis of healthcare personnel who
were in direct contact with the patient’s nasopharyngeal secretions are the
most important interventions.
Which federal agencies in the United States have
published regulations pertaining to infection and medical
or regulated waste?
1) U.S. Environmental Protection Agency (EPA)
2) U.S. Occupational Safety and Health Administration (OSHA)
3) U.S. Food and Drug Administration (FDA)
4) U.S. Department of Transportation (DOT)
a. 1, 2, 3
b. 2, 3, 4
c. 1, 2, 4
d. 1, 3, 4
C 1, 2, 4
Rationale: On the federal level in the United States, several agencies have
published regulations pertaining to “infectious,” “medical,” or “regulated”
waste. The U.S. EPA, OSHA, and DOT have such regulations. In addition, both
the CDC and EPA have issued guidance documents pertaining to medical
waste management. At the request of the U.S. Congress, the Agency for Toxic
Substances and Disease Registry prepared and published a comprehensive
review of the public health implications of medical waste.
Exposure to contaminated healthcare waste does not necessarily
result in infection. The following factors must be present for
contaminated waste to be capable of causing infection:
1) Dose and host susceptibility
2) Portal of entry
3) Portal of exit
4) Presence and virulence of a pathogen
a. 1, 3, 4
b. 1, 2, 4
c. 2, 3, 4
d. 1, 2, 3
B 1, 2, 4
Rationale: Pathogenic organisms are found in many different day-to-day
settings. Household garbage, bed linens, soiled diapers, and unwashed hands
are all examples of environments in which pathogens can be found routinely. A
number of studies have shown that though hospital wastes can have a greater
variety of organisms than residential wastes, those from households are
more heavily contaminated. For waste to be capable of causing infection, the
following specific factors are necessary: (1) dose, (2) host susceptibility, (3)
presence of a pathogen, (4) virulence of a pathogen, and (5) portal of entry.
All five of these factors must be present for infection to occur from waste.
Which of the following statements is true regarding the storage
of sterilized items in the Sterile Processing Department?
1) Sterilized items should be stored on a shelf with a solid bottom
2) Sterilized items should be stored in high traffic areas for
easy access
3) Sterilized items should be stored in a room with positive
air pressure
4) Sterilized items should be stored 8 to 10 inches from the floor
a. 1, 2, 3
b. 1, 3, 4
c. 2, 3, 4
d. 1, 2, 4
B 1, 3, 4
Rationale: Physical storage restrictions are recommended to support an
environment that is conducive to maintaining the sterility of reprocessed
items. Sterilized items should be stored as follows:
• Eighteen inches from the ceiling if there is a sprinkler head or according
to the fire code
• Eight to 10 inches from the floor
• At least 2 inches from an outside wall
• Away from sprinklers and air vents
• In areas of limited traffic
• Clean workroom or clean holding area(s): Airflow must be positive
pressure with respect to surrounding areas with a minimum of four air
exchanges per hour. In an area with controlled temperature and humidity
(18°C to 22°C [65°F to 72°F], relative humidity less than 35 to 75 percent,
and at least 4 [preferably 10] air exchanges per hour).
• Soiled workroom or soiled holding area(s): Airflow must be negative
pressure with respect to surrounding areas with a minimum of 10 air
exchanges per hour.
• The first item in is the first item out (first in, first out [FIFO]). Items
should be rotated. Place newer items in the back part of the area where
they are stored.
• Open-rack storage should have a solid bottom to prevent soiling or
contamination from the floor
• Consideration should be given to storage that will minimize the collection
of dust on surfaces
• Sterilized items should be arranged in a manner that prevents packages
from being crushed, bent, compressed, or punctured. Items should not be
stored under sinks or under exposed water or sewer pipes. Windowsills
should be avoided. Closed or covered cabinets are preferred. Open
shelving may be used if the area has limited access, has monitored
ventilation, and is frequently cleaned and disinfected.
