Prevention of Health Care Associated Infections

Question 1

HCI?

Answer 1

• growing
• most serious complications of hospitalization
• 5-10% of patients acquire it
• 4th leading cause of death in Canada
• 20yrs ago, they where 11th leading cause (growing)
• large proportion are preventable
• a-lot are UTI’s and pneumonia

Question 2

4 classes of surgical wounds?

Answer 2

1. clean (1-5% rate of infection)
2. clean contaminated (3-11% rate of infection)
3. contaminated (10-17% rate of infection)
4. dirty (over 25% rate of infection)

Question 3

Host susceptibility for HAI?

Answer 3

• age
• diabetes
• immune system
• obesity
• malnutrition
• duration fo surgery
• emergency surgery
• crowding
• pre-op length of stay
• remote infections

Question 4

Pre-op prevention strategies?

Answer 4

• showers
• hair removal
• skin antiseptic
• drapes
• prophylactic antibiotics

Question 5

Intra-operative prevention strategies?

Answer 5

• keep doors close din operating room
• duration of procedure
• insertion of drains, catheters and IV’s

Question 6

Prevention strategies: attire?

Answer 6

• surgical scrub
• masks
• gowns
• gloves
• caps
• shoe covers

Question 7

Prevention strategies: personnel?

Answer 7

• staying healthy
• no casual visitors
• traffic flow

Question 8

Environmental Control?

Answer 8

• clean air rooms
• laminar air flow rooms
• traffic flow
• sterilize equipment

Question 9

Daily, weekly, monthly cleaning?

Answer 9

Daily= floor, lights walls
Weekly= shelves, external vents
Monthly= hallways, storage areas

Question 10

Intravascular infection based on…?

Answer 10

• site
• prep
• aseptic procure
• daily observation
• preparation of IV solutions
• duration of IV left insitu

Question 11

Prevention of Urinary Tract Infections?

Answer 11

-primary risk is instrumentation and catheter care
-#1 HAI
-not a high cost to health care unless there is complications
-sterile
-use of catheters should be minimized
-peri-care
-maintain medical aseptic procedure
catheter bag below patients hips (reduce back flow)

Question 12

Nosocomial Pneumonia?

Answer 12

10-20% of nosocomial infections

• highest morbidity rate
• not present within 48-72 hours
• due to bacteria, virus, fungi
• spread by aspiration, inhalation, hematogenous spread
• fungi and unusual bacteria= primary risk to immunosuppressed
• transplant cases

Question 13

Associated risks with pneumonia?

Answer 13

• abdominal operations
• age (extremes)
• aspirate
• decreased ability to cough
• invasive procedures
• COPD, cystic fibrosis
• impaired immune systems

Question 14

Pneumonia prevention?

Answer 14

-immunizations
-aseptic procedures
antiseptic mouth wash
patient positioning
pre/post OP teaching
-disinfection practices

Question 15

Antiseptics? disinfectants? sterilizations?

Answer 15

AS- used on living tissue
DI- reduces microorganisms and can eliminate some
Sterilization- kills microbes including spores

Question 16

How to eliminate micro-organisms?

Answer 16

-sanitization, decontamination, disinfection, sterilization

Question 17

Critical items?

Answer 17

-come in contact with sterile body cavity/ sterile tissue
-require sterilization
ex= surgical equipment

Question 18

Semi-critical devices?

Answer 18

-only come in contact with mucous membranes or non-intact skin
-high level of disinfection
ex= endoscopes, anaesthetic equipment

Question 19

Non-Critical medical devices?

Answer 19

• items that come in contact with intact skin

- require sanitization

Question 20

Decontamination Process?

Answer 20

• removes blood, body fluids and tissue to ensure sterilization process
• makes items safe to handle

Question 21

Disinfection?

Answer 21

-thermal or chemical
used on inanimate objects
-eliminates most pathogenic micro-organisms with he exception of bacterial spores

Question 22

Low level of disinfection?

Answer 22

-kill most bacteria, some viruses and some fungi
cleaning general patient care, bedside, IV poles
inactivates mycobacterium TB, vegetative bacteria and most viruses

Question 23

High level disinfection?

Answer 23

• destroys all micro-organisms and some spores
• disinfect flexible scopes and small items
• requires special ventilation, PPE
• new technology= UV light

Question 24

Sterilization?

Answer 24

-destroys all micro-organism and all spores

Question 25

Types of sterilization?

Answer 25

• steam under pressure
• dry heat
• ethylene oxide gas
• chemical sterilants
• thermal disinfection (water at 93 degrees for 10 min)
• hydrogen peroxide weapon
• hydrogen peroxide gas plasma
• per acetic acid
• ozone

Question 26

Pasteurization?

Answer 26

reduces number of micro-organisms by mechanical means sing thermal disinfection (hot water 75-82 degrees)
-used with resp. equipment

Question 27

Disposable?
Single use?
Single patient use?

Answer 27

D- use once then discard
SU- use only once
SPU- repeated use by same patient, discarded on patient discharge

Question 28

Issues?

Answer 28

• antibiotic resistant organisms (MRSA, VRE, ESBL
• cleaning new complex instruments
• reprocessing single use devices
• impact of construction (ventilation, dust, water)