Safety Flashcards
Infection prevention Control
What are the 6 “links” in the chain of infection?
1- infectious Agent /causative Agent
2- Reservoir
3- portal of exit
4- mode of transmission
5- portal of entry
6- susceptible host
Infection prevention Control
What is an infectious agent?
Tip: causative agent
A microorganism capable of causing disease to humans
Infection prevention Control
What are the 4 main Infectious agents ?
Viruses (often there are vaccines for these)
Bacteria
Fungi
Parasite
Infection prevention Control
HIV, chicken pox, influenza, hepatitis are examples of what type of Infectious agent?
VIRUSES
this agents are the smallest and made up of DNA and RNA
Infection prevention Control
Pulmonary tuberculosis, streptococci ( strep throat) are examples of what type of Infectious agent ?
tip. Treated with antibiotics
BACTERIA
this agent is a single cell / reproduces rapidly
Infection prevention Control
How do bacteria a viruses reproduce and what is the difference?
|tip. Viruses are made of DNA and RNA and bacteria is a Cell!
Bacteria can reproduce itself
Viruses require a living host to reproduce ( must invade other cells to reproduce)
Infection prevention Control
Can bacteria survive without a host ?
Yes
Infection prevention Control
Can a virus survive without a host ?
No
Infection prevention control
Ringworm is an example of what type of Infectious agent?
FINGUI
single or multicelled / on skin but can invade deeper
Infection prevention control
Lice is an example of what type of Infectious agent?
PARASITE
|live on host and at the expense of its host
Infection prevention Control
What is a reservoir?
second on chain of infection
Where organism LIVES and GROWS between outbreaks.
Where germs live and thrive !
Infection prevention Control
What are examples of reservoirs?
People
Fomites (equipment, materials, doorknobs, table tops)
Vectors
Food
Soil, water
Feces
Infection prevention Control
What measures can you take to break the reservoir “link” of the chain ?
• wash hands
•clean, disinfect or sterilize environment and materials
Infection prevention Control
What measures can you take to break the Infectious agent “link” of the chain ?
•Chose the right cleaning products to kill pathogen
•seek medical help
Infection prevention Control
What is a Portal of exit?
third on chain of infection
Identifies how the infectious agent can leave the reservoir
How germs get out!
Infection prevention Control
What are examples of portals of exit?
Blood
Body fluids ( saliva, vomit)
Poop
Skin
By coughs and sneezes
Infection prevention Control
What measures can you take to break the portal of exits “link” of the chain ?
•wash hands
•PPE
•Properly disposal of trash
•covering your mouth when sneezing or coughing
Infection prevention Control
What is Mode of transmission?
fourth on chain of infection
Transmission identifies how an organism moves from one host to another host
How germs get around!
Infection prevention Control/Mode of transmission
What are the 4 main routes of transmission in an acupuncture clinic ?
- direct contact
- indirect contact
- droplets
- Airborn
Infection prevention Control/Mode of transmission
What is a vector?
living organism that transmits an infectious agent from an infected animal to a human or another animal
Examples: mosquito, fly, lies
Infection prevention Control/Mode of transmission
What are fomites ?
Tip: reservoirs in the chain of infection
objects or materials which are likely to carry infection, such as clothes, utensils, and furniture
inanimate objects
Infection prevention Control/Mode of transmission
What is DIRECT contact transmission?
Transmission by direct physical contact btwn. infected person and vulnerable person.
|human to human transmission
Infection prevention Control/Mode of transmission
Name an illness that can be transmitted by direct contact transmission?
Gastrointestinal infection
Infection prevention Control/Mode of transmission
What is INDIRECT contact transmission?
Transmission through an intermediary
|No direct human to human transmission
Infection prevention Control/Mode of transmission
Name an Illness that can be transmitted by Indirect contact?
Hepatitis B( can stay on equipment for over a week! )
Any inanimate objects can carry germs if not disinfected properly!
Infection prevention Control/Mode of transmission
What do we mean by transmission through droplets?
transmission due to contaminated splatter, cough, sneezing or talking
Contact with eyes or mouth
Infection prevention Control/Mode of transmission
Name examples of diseases transmitted by droplets ?
6 points
Tip: think of illnesses where you sneeze or cough
Influenza- virus
Mumps -virus
Colds
Pertussis ( whooping cough)- bacteria
Rubella - virus
SARS- virus
Infection prevention Control/Mode of transmission
What do we mean by airborne transmission?
Residue from evaporated droplets or infected dust particles can stay suspended in the air for a long time
Air currents make them travel
Infection prevention Control/Mode of transmission
What is an example of airborne diseases?
3 points
Measles- virus
Chicken pox- virus ( varicella- zoster)
TB- bacteria ( breathing in droplets from sneeze or cough )
Infection prevention Control/Mode of transmission
What can you do to prevent direct contact transmission in a clinic ?
Wear a mask / gloves
Offer hand sanitizer to patients
Clean with a low level disinfectant
What can you do (to prevent transmission) if you have a patient that suffers of an air born disease ?
Try to see him at the end of the day
Wear High efficiency N95 masks
Open windows
Offer masks and hand sanitizer
Infection prevention Control
What is Portal of entry?
fifth on chain of infection
Tip: it informs the practitioner on the PPE that may be required
Site where organism can gain access to the host
How the germs get in!
Infection prevention Control
What measures can you take to break the portal of entry “ link” of the chain ?
Wash hands
Aseptic technics during procedures
Taking proper care of wounds ( wear gloves)
Infection prevention control
Give some examples of portals of entry
Mucous membranes
Breaks in the skin
⚡️NEEDLE PUNCTURE
Infection prevention Control
What is a susceptible host( vulnerable host)?
sixth on chain of infection
Person who lacks of immunity or resistance.
Reproduction of the microorganism can happen and cause infection!
Next sick person!
Infection prevention Control
Give some examples of susceptible hosts?
Elderly
Children
People with weakened immune
system
Unimmunized people
contamination and cross- contamination
SHARPS
What is a common accident can occur by unsafe disposal or handling of sharps ?
Acu needles, dermal needles, plum blossom
Needle stick accident
sharps become easily and regularly contaminated by blood or fluids
Infectious organisms can spread throughout the clinic by contamination and cross- contamination
What is contamination?
Unintentional spread of infectious organism TO AN OBJECT such as acu.needle or herb storage container
contamination and cross- contamination
What is cross-contamination?
Indirect spread of an infectious microorganism from A PERSON TO ANOTHER PERSON via unclean instruments or improper sterilization
contamination and cross- contamination
What practices can cause contamination and cross-contamination?
-clean equipment or instruments, placed on unclean surfaces.
-sterilize, equipment or instruments, placed on non-sterilized surfaces
-inadequate acupuncturist
-contaminated instruments, not disposed promptly and appropriately.
-linens are not cleaned
Biological Hazard chart
Common infections in Acu clinics
What is Hepatitis B?
How does it transmit?
Can it be cured ?
Vaccine available ?
How can TCM professional protect themselves?
HBV
⚡️Viral Infection 🦠 by Hepa. B virus causing swelling of the LR
⚡️Blood born 🩸
⚡️NO cure! but the infection can be controlled.
⚡️vaccine✔️
⚡️ vaccination and use of CLEAN NEEDLE TECHNIQUE
Common infections in Acu clinics
What is Hepatitis C ?
How does it transmit?
Can it be cured ?
Vaccine available ?
HCV
⚡️Viral Infection 🦠 by Hepa. C virus.
Acute and chronic symptoms
⚡️Blood born 🩸
⚡️Yes, it may be possible
⚡️vaccine 👎🏼
Common infections in Acu clinics
How can we reduce the risk of HBV and HCB infection in a clinic setting ?
both blood born 🩸🩸
- Clean needle technique
- single use, sterilized needles
Common infections in Acu clinics
What is Hepatitis A ?
How does it transmit?
Can it be cured ?
Vaccine available ?
Frequently evidenced in locations with poor sanitation
Less severe than A and C
HAV
⚡️Viral Infection 🦠 by Hepa. A virus.
⚡️Through contaminated food / water /fecal matter
⚡️Yes, it may be possible
⚡️vaccine ✔️
Common infections in Acu clinics
How can we reduce the risk of HAV infection in a clinic setting ?
-regular hand washing
- regular use of alcohol- based swab
Common infections in Acu clinics
What is Human Immunodeficiency Virus (HIV)?
How does it transmit?
To what other illness can it lead to?
HIV
⚡️progressive deterioration of the immune system -> infections
⚡️Blood born 🩸
⚡️ It can lead to AIDS
Common infections in Acu clinics
What is Influenza ( the flu) ?
How does it transmit?
What part of the population is more at risk?
⚡️respiratory track affected by Influenza virus 🦠
⚡️droplets born
⚡️the elderly or weak
ROUTINE PRACTICES
What is a routine practice based on ?
Identifies procedures that apply at all times and with all patients
All patients are a potential source of infection
All blood, body fluid ( except tears and sweat) , secretions, none- intact skin, undiagnosed rash, mucous membranes are potentially contagious
ROUTINE PRACTICES
What are the 4 routine practices an acupuncturist should know?
Conducting risk assessment
Hand hygiene
Use of PPE
Safe handling of disposal sharps
ROUTINE PRACTICES
What is conducting risk assessment and when should it be performed by an acupuncturist?
It’s an overall strategy for clinical safety ! Analyze and assesses how risk can be minimized.
Should be done before each patient interaction
ROUTINE PRACTICES
Respiratory Etiquette
What are the steps to cover your respiratory secretions?
ROUTINE PRACTICES
Hand washing
What are the steps to hand washing ?
ROUTINE PRACTICES
Hand washing
When should you wash your hands in clinic ?
8 points
Before and after contact with patients
When hands are visible soiled
Before needling
Before removing needle
After removing gloves
Contact with contaminated articles
After inadvertent exposure to blood or body fluids
ROUTINE PRACTICES
Hand washing
What is a preferred method of decontaminating hands when hands are not visibly soiled?
Hand washing or ABHR (alcohol based hand rubs) ?
ABHR
apply for 15 sec. Allow it to air dry
ROUTINE PRACTICES
Antiseptic Agents
What is an acceptable disinfectant for the skin before needling ?
Isopropyl 70%
do not overlap area that has been cleaned
ROUTINE PRACTICES
What is the difference btwn antiseptics and disinfectant ?
Antiseptics are germicides used on skin and tissue
Disinfectants (DIN numbered) are germicides used on inanimated objects ( does not kill BACTERIAl spores )
ROUTINE PRACTICES
PPE
What are the two main PPE used in an acu. Clinic ?
😷masks
🧤 Medical gloves - wear at all times if your have HBV or HIV
ROUTINE PRACTICES
Safe disposal of SHARPS
What is the first thing you should do right after you have removed a needle ?
How full can sharps containers be ?
Dispose of needle immediacy after use, ONE BY ONE! - wash hands
Sharps containers should never be filled more that 75% or 3/4 of their capacity!
ADDITIONAL PRECAUTIONS
Use when routine practices are Not enough to stop transmission!
Name additional precautions for infectious patients
Arrange waiting room with 2 meters of distance
Post signs with respiratory etiquette
Post signs - respiratory or gastrointestinal to let your practitioner know !
ADDITIONAL PRECAUTIONS
Name additional precautions for droplet transmission and contact transmission
Triage the patient from waiting room
Masks , gloves
Wipe all with a low level disinfectant
+ Work 2 meters from patient for droplet transmission
+ offer Hand sanitizer and wear a gown for contact transmission
ADDITIONAL PRECAUTIONS
Name additional precautions for airborne transmission
Triage the patient from waiting room
N95 mask
See patient at the end of the day
Open windows
If treating chickenpox, or measles vaccine required
CLEAN, DISINFECT, STERILIZE
What level of disinfectant do you use for general housekeeping ?
Non Critical / Low Risk
low level disinfectant
⚡️1:500 bleach solution
⚡️quaternary ammonium
⚡️3% hydrogen peroxide
⚡️phenols
Examples: Pine Sol, Fantastic, Clorox
Note: splatters can be cleaned with low or intermediate level ( 1:10)
Low Level will not kill TB, Fungus or Spores
cleaning blood spills
What cleaning category do you use for blood spills?
Intermediate level disinfectant or hospital grade disinfectant
As an alternative we can use
1:10 dilution of bleach and leave for at least 30 min.
- wear utility gloves
- blot blood with paper towels
- clean with disinfectant.
- Dry with disposable paper towel
CLEAN, DISINFECT, STERILIZE
What cleaning category do you use for clinical contact surface ?
Low level or intermediate level disinfectant if necessary
CLEAN, DISINFECT, STERILIZE
How should you do laundry with vissible soil, no soil or with blood ?
Visible Soil
Add Bleach
No Visible Soil
Wash in 70 to 80 degrees Celsius with soap
Bloody linen
handled separately in an none porous bag
What are the steps taken when you begin to make non sterile item sterile or safe to use in practice?
- soak
- clean (remove soil )
- rinse
- air dry
- sterilize (kill all forms of microbial life!)
Or - disinfect ( kills microorganisms but not all germs or spores)
CLEAN, DISINFECT, STERILIZE
How do you clean critical items?
Critical items- enters sterile tissue/ skin ( including bloodstream)
Acu needles
1- cleaning
2-Sterilization or high level disinfectant for items that can’t withstand sterilization
CLEAN, DISINFECT, STERILIZE
How do you clean semi critical items?
Semi critical: contact with none intact skin ( no penetration)
Cupping devises ( cupping on needle )
1.Cleaning
2. High level disinfection
sterilize if bleeding occurs or if cupping over a needle
CLEAN, DISINFECT, STERILIZE
How do you clean non critical items?
Non-critical : contact with intact skin. ie: Tuina devises, electrical clips, cups
1- Cleaning
2 Low level disinfectant
What is the recommended shelf life for bleach solutions ?
24 hrs
What’s the most powerful way of killing all form of micro oak organisms ( including bacterial spores )?
Sterilization
Any item that is invasive or pierces the skin must be sterilized
use steam autoclave
Immunization
What are the 2 vaccines recommended for TCM practitioners and staff ?
HBV
Tetanus
also consider: flu , measles, mumps, polio, diphtheria
Name the main 3 blood born pathogens that could affect a TCM practitioner ?
HIV
HBV and HCV
What are the two main types of sterilization?
Steam( autoclave)
Dry heat
sterilization is confirmed by spore tests
How do you manage cups that have come in contamination with blood or other potential infectious materials?
If you do not own an autoclave use single use disposable cups and dispose of the cups after each use in a biohazard waste disposal bucket
blood born diseases: precautions and management
What should u do if you are exposed ?
avoid exposure by accounting for every needle that is inserted
1-provide first aid: clean with soap and water. do not milk the wound
2-report the incident to clinic supervisor to assess patient status
3-sick expert advice: post- exposure prophylaxis. call 811 health-link
Treatment should be sought within 72 hrs
4- document incident
Safe procedures and risk management
What is clean needle technique (CNT)?
also called : aseptic acupuncture technic
Procedure for needling ( insertion and withdrawal) done in such a way that the risk of infection reduces to a minimum
Safe procedures and risk management
What are the 5 basic principles of CNT?
1- was hands
2- use sterilized needles
3- store needles in a safe, clean and well ventilated area
4- stabling clean field BEFORE performing acupuncture
5- immediate discard of used needles
Safe procedures and risk management
What part of an acupuncture needle must remains sterile at all times?
The shaft
What level disinfectant do you use to clean the handle of a seven star/ plum blossom needle ?
only use handle with same patient! New head each session
High level
What are the 4 Steps to prepare clean field?
1- clean surface with low level disinfectant
2-use HBHR or wash hands
3- please materials on C.F
4- place sharps / waste at a safe distance
What are the 3 steps taken before needling a patient to ensure patient safety?
- 🧼 ABHR or wash hands
- 👀 inspect for skin lesions, or contraindications
- Disinfect with a new swab 70%
if you choose to locate point by touching the patient, you must re-wash hands before needling
When do you have to use medical gloves ?
When using any method that could cause bleeding or exposure to body fluids
Or
if practitioner or patient has rashes or open lesions on skin
Example:
lancets
three edge needles
plum blossom
Seven star
contraindication and precaution to acu
What ear points do we avoid during pregnancy ?
Ovaries and uterus
contraindication and precaution to acu
What points do we avoid during the 9 months of gestation with any technique? 10 points
due to their oxytocic effect (stimulation of contraction uterus)
Sp6
GB21
BL60
All points through foramen:
BL 31-BL34
BL67 ( turns fetus)
CV4
KD6
contraindication and precaution to acu
What should you do if a patient has a stroke or MI?
Call 911
TCM professionals should know first aid and CPR
contraindication and precaution to acu
Can acupuncture be used alone to treat malignant tumours?
Only if advanced training has been abstained
Only use acupuncture as a complementary measure to relieve pain or side effects of chemotherapy
contraindication and precaution to acu
Should you do acupuncture in patients on blood thinning medication ?
No, acupuncture may be contraindicated or special caution is required
Acupuncture should not be performed on what type of patients?
Patients who have been:
Drinking
under influence of drugs
haven’t eaten in a long time
just finished vigourous physical activity
Are confused
emotionally unstable
have needle phobia
contraindication and precaution to acu
Should you do electro - acupuncture on patients with a a pacemaker or electronic implants ?
NO
adverse reactions
Name the main four adverse reactions or accidents that could happen when needling ?
Fainting
bent needle
stuck needle
broken needle
contraindication and precaution to acu
What is a side effect?
Undesirable effects, which may occur in addition to the desire therapeutic effects
contraindication and precaution to acu
What is an adverse reaction?
Unexpected and undesirable effects that are not predicted or foreseen
contraindication and precaution to acu
What can cause fainting?
Fatigue
no previous treatment
uncomfortable positioning
overly forceful needle
manipulation or over stimulation
contraindication and precaution to acu
What is the main cause of a stuck needle ?
Patients muscle spasm or sudden movement
but it can also result of rotation with two wide, an amplitude or rotating in only One Direction, causing the needle shaft to tangle with the muscle fibres
contraindication and precaution to acu
What are the main causes for a broken or bent needle?
Poor needle quality.
Erosion or cracks between shaft and handle
Spasms or sudden movements
Improper withdrawal of stuck needle or bent needle
Excessive force manipulation
Needle is stuck by external force
contraindication and precaution to acu
What part of the needle is the most prone to break?
keep 1/4 of shaft of needle above skin
Junction of the handle and the shaft( root of needle )
contraindication and precaution to acu
Steps to broken needle
contraindication and precaution to acu
What can you do to prevent a hematoma?
mild pressure
Hot compress or indirect moxa to promote absorption
contraindication and precaution to acu
What is advised to patients after gua sha or cupping ?
Stay warm and avoid chills for one to two days
contraindication and precaution to acu
When is moxa contraindicated ?
Near large blood vessels
On face
CV14 CV15
Near mucous membranes or sensory organs
Abdomen/lower back of pregnant woman
contraindication and precaution to acu
What patients should not receive moxa?
Hungry patient
Over eaten
very weak
Fatigued
Intoxicated
contraindication and precaution to acu
Can we heal blisters if they happen after moxibustion ?
No, it’s not in our scope of practice.
What is concidered a semi-critical device?
A device that comes into contact with mucous membranes or non- intact skin, but ordinarily does not penetrate them.
What is concidered a Critical device?
A critical medical device is a device that penetrates the skin or mucous membranes, has contact with blood and or body fluids.
What is concidered a non-critical device?
Devices that touch only intact skin but not mucous membranes, or devices that do not directly touch the patient.
What are two reasons a practitioner MUST refer a patient?
- Limitations of personal training and skills
- Limitations of TCM and acupuncture
What is the main purpose and goal of the patient records?
For the registered acupuncturist to provide quality care to the patient
Whose responsibility is it to collect, organize and store all information that is obtained during each patient consultation?
The practitioners
3 Reasons to take accurate records of patient?
- External review by the CAAA
- In case of investigation
- For self assessment and learning from experiences
What is included in Patient Records?
- Informed consent
- Cumulative Patient profile
- Intake forms
- Clinical notes
- SOAP
What does SOAP stand for?
Subjective Data
Objective Data
Assesment
Plan
Who is responsible for the accuracy of the patient records?
The treating practitioner
Patient records are confidential. Who is responsible for ensuring the safty of the records?
- The acupuncturist
- The clinic administration (if applicable)
The language used in Patient records must be 4 things….
What are they?
Factual
Objective
Non Judgemental
English
Hand written notes must be written with ?
Permanent Ink
Can modifications be made to a patient record?
Can information be removed from the record?
YEs
NO
How can a record be properly modified?
- incorrect information must be struck out by a straight line
- additions have to be dated and initialed with brief explanation for modification
How are acupuncture points properly recoreded in patient record?
- Numbering or Naming system
- WHO standard acupuncture point location
- Extra points must have a literature refrence of their name
Where is it preferred to write the patients name on the documents ?
At the top
What does an Antimicrobial do?
Kills microorganisms or stops their growth.
Example:
sterilizers, disinfectants, and sanitizers.
Can patient records be sent by email?
NO.
Unless there is encryption
Can a parent access Child’s file if child is 18?
NO.
If child is capable of making their own treatment and privacy decisions (18yrs in Alberta) parent can not access
Who can a patient complain to if they believe their privacy has been violated?
PRIVACY COMMISSIONER OF ALBERTA
How long must a practitioner keep Patient records for?
5 years
or
5 years after they turn 18
(though statue of limitations says it’s good to maintain records for 10 years or more)
Standards for electronic patient records:
4 points
- appropriate passwords and controls
- audit logging is enabled
- not accessed remotely
- backed up regularly
Must you keep a register of records that have been destroyed?
YES
To terminate a Patient / Practitioner relationship, the practitioner must provide written notification to patient.
It must include 2 points.
What are they?
Reason for termination
Date of termination
4 Elements of Informed Consent we must know:
P
A
PBR
P Procedure
A Alternative Procedure
PBR Potential Benefits and Risks
If a patient is asked to sign a form without having had a discussion with practitioner, has the practitioner managed risk?
NO
The actual consent is the dialogue that occurs between the practitioner and the patient.
Name 3 circumstances in which the Practitioner has a ‘Duty to Report’?
- suspected Child abuse
- Suspected Elder abuse
- Communicable and reportable disease
Practitioner should inform patient of duty to report without putting themselves or their patient at risk
What is the only part of the needle the practitioner is allowed to touch?
HANDLE
When can medical gloves replace handwashing?
Only when hand washing is NOT possible
What is one of the most common injury from receiving acupuncture?
Pneumothorax
If a patient develops:
chest pain
dyspnoea
cough
shortly after or immediately after treatment, what may have occurred?
Pneumothorax
Injury to lung or plura
If a patient develops:
localized pain or tenderness
stiffness of the abdominal muscles
a tear with bleeding
What organs were possibly injured during treatment?
LIVER
SPLEEN
If a patient develops:
pain in lumbar region
evidence of blood in urine
What organ was possibly injured during treatment?
KIDNEYS
If a patient develops:
headaches
nausea
vomiting
slow respiration
What may have been injured during treatment?
Brainstem
Medulla Oblongata
If a patient experiences:
lightening pain
loss of sensation
loss of movement
What may have been injured during treatment?
CNS
