Prevetning and Controlling Transmission Of Infectious Agents Flashcards
Reservoir strep penumo
Human
Animal reservoirs for influenza
Swine, birds
Reservoir for worms
Dogs
Animal reservoir for salmonella
Turtles and snakes
Animal reservoir for rabies
Bats and raccoons
Reservoir for babesia
Ticks
Reservoir for Rocky mountain spotted fever
Tick
Reservoir for West Nile virus
Mosquito
Reservoir for cryptosporodia
Water, food
Reservoir for salmonella
Food
Reservoir for listeria
Food
Reservoir for staph aureus
Human
Reservoir for c diff
Human (can also be in env)
Reservoir for aspergillus
Dust in env
Reservoir for legionella
Water
Reservoir for cryptococcus fungi
Soil
Reservoir for coccidiodes
Soil
Reservoir for sporothrix
Plants
Portals of exit in humans
Sneezing
Coughing
Saliva
Vomit
Diarrhea
Open wounds
Semen
Examples of portals of entry
Indwelling urinary catheters
IV devices including central lines
Ventilators
Surgical procedures
Basic steps to prevent the transmission of microbes between HCP, patients, and the environment.
Standard precautions
Describe standard precautions
Used for care of ALL patients, in ALL healthcare settings
Transmission of infection requires these 3 elements:
Mode of transmission, vulnerable host, source of infection
Standard precautions protect both HCP and patients from infection, and prevents the spread of microbes between hosts through …
Direct Person to person transmission or indirect person to environment to person transmission
Basics of standard precautions
- Hand hygiene
- PPE
- Resp hygiene/ cough etiquette
- Safe work practices
- Env cleaning
- Safe injection practices
- Patient placement
Single most effective measure that can be taken to decrease the transmission of organisms
Hand hygiene
When is soap and water required?
Outbreaks of C. Diff and norovirus, bacillus anthracis
Moments for hand hygiene
- After contact with blood, body fluids, secretions, and excretions
- After touching contaminated items
- Before AND after using gloves or other PPE
- Between contact with each patient
What it is important to use soap and water for spore forming organisms
Soap and water washes the spores away that are resistant to the chemicals
Purpose of PPE
Protect skin, eyes, mucous membranes, airways, and clothing from infectious agents
When should gowns be worn?
When performing patient care activities or procedures in which exposed skin or clothing can be exposed to any patient blood, body fluids, secretions, or excretions
When handling equipment or env surfaces that have been contaminated
Difference in gowns in regular HCP settings versus surgery and trauma
Surgery - fluid proof (see larger amounts of blood)
Reg healthcare- fluid resistant
When should gloves be worn?
When touching mucous membranes or non-intaxt skin of a patient
When touching patient blood, body fluids, secretions or excretions or
When handling equipment that has been contaminated
When should masks be worn?
For sprays of blood or bodily fluids, particularly resp secretions
What is the purpose of surgical masks?
Protect the patient from infectious agents possibly in the HCPs nose or mouth during sterile procedures
When to wear eye protection (goggles or face shields)
When sprays or splashed of resp secretions, blood, or body fluids my feet until eyes, face, or mucous membranes
Specific examples of sterile procedures when HCP should wear surgical mask
- Insertion if catheter
- Injections into spinal or epidural spaces during lumbar puncture procedures
True or false- glasses offer adequate eye protection
False
What is source control?
Usually mask, protects others from the wearers resp droplets/ infectious agents
Describe the competents of respiratory hygiene/ cough etiquette
- educate on signs and symptoms of respiratory illness
- post signs at facility entries
- source control accessible
- hand hygiene easily accessible (esp entrance/ waiting areas)
- those with resp symptoms sit at least 3 ft from others
Special considerations for resp hygiene for HCP
If HCP symptomatic, refrain from providing patient care
If HCP must provide care, wear mask as source control
Examples of safe work practices
- don’t touch mucous membranes
- position patients to avoid splatters/ sprays
- PPE positioned properly
- barriers used for resuscitation
Standard precautions for env cleaning- direction to clean
Top to bottom
Clean to dirty
How often should noncritical equipment be cleaned?
After each patient use
Best practices for soiled and contaminated equipment
-handle to prevent microbe transfer to HCP and env
- store separately from clean equip
Examples of noncritical items
Vital signs machines (like pulse oximeters and reusable blood pressure cuffs), blood glucometer devoces
What are the rules of safe injection practices?
- one needle, one syringe, one time
- open sterile package immediately before use and keep from contamination
-single dose vials preferred - never recap, bend, or break used needles
- engage safety devices immediately after use
- dispose of in sharps container
What is the rule for the diaphragm of the vial before injection?
The diaphragm (rubber part at top) must be disinfected with antiseptic (typically alcohol wipe) immediately before accessing with a needle
Advice for recapping needles
Avoid recapping
If you must, then use 1 hand technique
When should safety devices on syringes be activated?
Immediately after injection given
Disposing of used sharps
Dispose of in puncture resistant container designated for sharps disposal
Under what circumstances should a patient have a single room?
- Increase risk for transmission
- Likely to contaminate the environment
- Not able to maintain appropriate hygiene
- At increased risk for acquiring infections (immunocompromised)
- At increased risk of developing adverse outcomes following an infection
Another name for transmission based pecautions
Isolation pecautions
True or false, standard precautions still apply when implementing transmission based precautions
True
Why screen for organisms that can colonize like MRSA or VRE
Unidentified patients who are colonized or infected with infectious agents represent a risk to other patients and hcp
What are the different types of transmission based precautions
Contact precautions
Droplet precautions
Airborne precautions
Protective environment
Can you implement multiple types of transmission based precautions at the same time?
Yes
When should contact precautions be used?
VRE, MRSA, ESBL, C Diff
What are contact precautions
- single room
- PPE- gown and gloves
- dedicated or disposable equip
- clean hands before entering and after leaving
- limit transport outside of room to medically necessary purposes
- clean daily with focus on high touch areas and areas close to patient
What additional precautions are needed for C Diff
- spore forming oeganidms require disinfectant with 1:10 bleach solution
- gloves!
- soap and water during outbreaks to physically wash spores from hands
Does abhr kill spores? E
No
What organisms are droplet precautions commonly used for
Influenza
RSV
Pertussis
Bacterial meningitis due to neisseria meningitis or haemophilus influenzae
What are the droplet precautions
- single room
- mask and eye protection
- limit transport
- when outside of room, patient to wear mask
- clean daily with focus on high touch areas
When are airborne precautions used?
TB, varicella, measles
Room for airborne precautions
Airborne infection isolation room
How many air exchanges per hour does an AIIR have? Where does exhaust go?
6-12, directly exhausted outside
PPE for airborne precautions
N95 if higher resp, or PAPR
Airborne precautions
- AIIR
- N95
- limit transport
- patient wears mask outside of room
- clean daily with focus on high touch areas
- door stays closed
Another name for protective environment
Reverse isolation
Who is a protected environment recommended for?
Patients with weakened immune system to reduce the risk of invasive, opportunistic pathogens
Example of patient who would need a protective env
Allogenic hematopetic stem cell transplant recipient
Type of filtration and number of air exchanges for protective environment
hEPA filtration
12 air exchanges per hour
Bathing method on protective environment
Baths instead of showers to prevent aersolizarion
Any changes to nutrition for protective environment?
No
What PPE in protective env?
Droplet/ contact PPE
Rules for plants in protective environment
No fresh flowers or potted plants
When to use droplet for meningitis
N. meningitidis or haemophilus influenzae