UNIT 5- REDO

Question 1

what is disinfection?

Answer 1

processes that render an object non-infective

Question 2

what is sterilization?

Answer 2

The destruction of all living organisms, including spores

Question 3

what is decontamination?

Answer 3

The process followed to ensure that usable medical devices are safe to use on the next patient

Question 4

what is Asepsis

Answer 4

The absence of pathogenic organisms

Question 5

what is Antimicrobial agent

Answer 5

A General term used for drugs, chemicals or other substances that kill or slow down the growth of micro organisms

Question 6

What is clinical waste?

Answer 6

This is generally defined as waste from a healthcare facility that may contain hazardous pathogens. Examples include:
* Any material contaminated with patient blood or bloody body fluids (e.g. wound exudate, pus)
* Other body fluids (cerebrospinal fluid, amniotic fluid, semen, vaginal secretions).
* Other special types of waste are generated from healthcare facilities including expired medication, chemicals and oils. These are also potentially hazardous and require a programme for disposal, separate from management of clinical and general waste.

Question 7

What is waste management?

Answer 7

Waste management is the handling and safe disposal of infectious and non- infectious waste.
* The aims of waste management are to ensure safe and environmentally friendly destruction or reprocessing of healthcare waste.

Question 8

What is waste segregation?

Answer 8

This is simply the separation of healthcare-associated waste at source into clinical (infectious waste) or non-clinical (domestic) waste.
* Waste segregation takes place at the point of generation (source) into different (colour-coded) plastic bags or containers for disposal.
* Separation of waste at source (i.e. at ward or clinic room level) saves time, cost and eliminates the risk attached with sorting medical waste.
* Many healthcare facilities use colour-coded waste bags and posters/signs to indicate to healthcare workers and visitors where the disposal of different types of waste must take place.
* For example, red bags for clinical waste and black or clear bags for non- clinical waste and general rubbish.
* Sharps are disposed of at source in robust solid containers to avoid accidental injuries.

Question 9

How are sharps managed?

Answer 9

This is the risk management programme (part of standard precautions) that is implemented to reduce the risk of sharps (or needlestick) injuries.
* The following recommendations apply to waste management of sharps:
o Puncture-proof containers should be used.
o Sharps containers should be securely wall-mounted or fixed to
procedure trolleys.
o All sharps containers should be labelled with the date and location.
o Sharps containers should be removed when filled to the indicated two-
thirds full mark.
o Sharps containers should be securely closed and transported to a safe
storage area until collected for final destruction.

Question 10

How is medical waste transported?

Answer 10

When removing waste from clinical areas, the domestic staff should ensure that:
* The waste containers have been properly sealed i.e. by sealing waste boxes with tape, closing the lids of sharps containers securely, or by placing soiled linen in leak-proof bags.
* The waste boxes and sharps containers are labelled correctly with the date, institution name and name of the clinical area where the waste was generated.
* A waste cart or trolley that is leak-proof and clean is available to remove the waste.
* The domestic staff should wear appropriate personal protective equipment (PPE), e.g. heavy duty gloves, apron and closed shoes.

Question 11

What is decontamination?

Answer 11

Decontamination is the process followed to ensure that re-usable medical devices are safe to use on the next patient.
* Examples are the decontamination of a vaginal speculum between patients or the decontamination of surgical instruments between operations.

Question 12

What are the steps in the decontamination process?

Answer 12

Cleaning (physical removal of organic material including micro-organisms)
* Disinfection (killing or destruction of most but not all disease-producing
micro-organisms)
* Sterilization (destruction of all micro-organisms).

Question 13

What is the correct method of cleaning of medical devices?

Answer 13

For medical devices and instruments that can be safely immersed in water, the following steps apply:
o Wear domestic gloves, aprons and visors to protect your mucous membranes
o Fill a sink or tub with warm water
o Add detergent according to the manufacturer’s instructions
o If applicable, disassemble the instrument fully
o Hold the item below the surface of the water
o Using a soft nylon brush, clean all surfaces, grooves and hinges of the
instrument
o Inspect the instrument thoroughly to ensure all visible organic material
is removed
o Prepare the item for disinfection or sterilization as needed.

Question 14

What is the role of disinfection?

Answer 14

Disinfection is the killing or destruction of most pathogens, and is applied to inanimate (non-living) surfaces or instruments.
* This process will not kill all pathogens (especially spore-forming pathogens), but reduces the level of contamination to one that is not harmful.
* Microbial killing by disinfection can be achieved using chemicals, heat or both.
* The use of heat for either disinfection or sterilization is the preferred method for making items safe for re-use. However, for heat-sensitive items (endoscopes/electrical equipment) or surfaces (mattress covers, worktops, etc.), chemical disinfection is an acceptable alternative.

Question 15

The advantages of using disinfectants?

Answer 15

Disinfectants are generally inexpensive, have rapid action, can be used for processing at the point of use and are suitable for decontamination of heat- sensitive items.

Question 16

The disadvantages of using disinfectants?

Answer 16

The negative aspects of disinfectants are that they are less effective than heat, require rinsing of items, may enhance antimicrobial resistance, may be harmful to the environment and can cause allergic reactions.

Question 17

Why is it not acceptable or effective to soak instruments in disinfectants?

Answer 17

No device or instrument can be effectively disinfected or sterilized unless it has been thoroughly cleaned.
* Soaking used medical devices in disinfectants is a waste because most disinfectants cannot penetrate organic matter.
* The act of soaking gives healthcare workers a false sense of security, whereas in fact the device or instrument has usually not been adequately decontaminated.

Question 18

What is the difference between disinfectants and antiseptics?

Answer 18

Disinfectants are used for killing pathogens on inanimate surfaces or instruments.
* Antiseptics are chemicals used to kill pathogens on live tissue, for example alcohol hand-rub, chlorhexidine gluconate and povidone iodine for skin preparation prior to surgery.

Question 19

what is cleaning?

Answer 19

Cleaning (in the healthcare setting) refers to the removal of visible dirt dust and debris. Cleaning alone results in large reductions in environmental contamination, including the removal of many pathogens.

Question 20

What is the role of the environment in infection transmission?

Answer 20

A clean patient environment contributes to prevention of nosocomial infection.
* Cleaning in healthcare facilities aims to remove visible dirt and dust, reducing
levels of harmful micro-organisms in the patients’ surroundings.
* Dust contains skin scales and micro-organisms, which can be spread in the
environment and air by sweeping or dry dusting.

Question 21

how often should a healthcare facility be cleaned

Answer 21

Most areas of a healthcare facility will require at least daily cleaning. Other specialised clinical areas may require twice daily (outpatient areas) or more frequent cleaning (operating theatres).

Question 22

what is the cleaning equipment that is used

Answer 22

Cleaning cloths: These should ideally be colour coded to distinguish cloths
used for ‘clean’ areas from those used for highly contaminated areas, e.g. toilets, baths and isolation areas. Where a colour coding system is used, it is important to ensure that all staff is aware of which equipment may be used for cleaning which areas.
* Cleaning buckets/carts: Should be cleaned daily or whenever heavily soiled.
* Mops: Flat mops are preferred to the ‘spaghetti’ mop type. Mopping water
and detergent solution should be changed frequently. Proper storage of mops is important so that they can be allowed to dry thoroughly and without cross- contamination of the mop heads.
* Floor polishers: Where these are used the machines should be emptied and cleaned daily.
Storage area: Each clinical area should have a dedicated cleaning store/closet. It is important to ensure that all equipment is stored dry, and inspected for damage prior to use.

Question 23

What are the general cleaning principles used in healthcare facilities?

Answer 23

A cleaning programme should be in place (including cleaning protocols, regular staff training and monitoring of adequacy of cleaning)
* A standard, institution-approved detergent should be used in all areas (unless otherwise specified by the IPC practitioner)
* The manufacturer’s instructions regarding dilution of cleaning solutions should always be followed
* Surfaces must be allowed to dry completely (as damp areas encourage growth of micro-organisms)
* A cleaning plan should be devised for each clinical area, working from areas of least contamination to areas of most contamination, e.g. from administrative areas to toilets to isolation rooms.
* All surfaces should be easy to clean, compatible with hospital detergents and disinfectants, smooth and nonporous.
* All carpets should be removed as these are very difficult to clean.

Question 24

What are the areas that are frequently touched in healthcare facilities?

Answer 24

Items such as door handles, light switches, patient monitors and medical equipment buttons/knobs are frequently touched by healthcare workers and patients.
* These are high-risk surfaces for cross-transmission because they hold the micro-organisms that are transferred from people’s hands.
* Domestic staff should be specifically alerted to give extra attention to these frequently touched surfaces during their routine cleaning.

Question 25

What is the difference between routine cleaning and terminal cleaning?

Answer 25

Routine cleaning is the standard, everyday procedure for cleaning of clinical areas, including mopping of floors, damp dusting of surfaces with detergent, etc.

• Terminal cleaning is performed when a patient with a transmissible illness is discharged (usually for isolation rooms), e.g. MRSA and other drug-resistant bacteria, tuberculosis, Clostridium difficile.

Question 26

How should blood spills be managed?

Answer 26

The following principles should be applied:
* All blood spillages should be immediately cleaned up.
* Domestic gloves should be used.
* Glass and solids should be removed using a brush and pan,
* and discarded in a sharps container or
* if too large, wrapped in newspaper before safely disposing.
* The remaining fluids should be blotted using as many paper towels as
needed,
* these should be discarded in the clinical waste container.
* Water and detergent should be used to remove all visible blood.
* The area should be wiped over with a chlorine-based solution
* and allowed to dry.

Question 27

what is antimicrobial resistance

Answer 27

Antimicrobial resistance is the ability of micro-organisms to grow in the presence of a chemical or drug that would normally kill them or slow their growth.

Question 28

how is antimicrobial resistance developed?

Answer 28

Micro-organisms evolve constantly and are able to survive difficult conditions by adapting to new environments. Factors contributing to the rapid development of antimicrobial resistance are the overuse and misuse of anti-microbial drugs, some disinfectants and related chemicals.

Question 29

How does antimicrobial resistance develop

Answer 29

-Certain micro-organisms are naturally resistant to some types of antimicrobials.
But resistance can also develop (be acquired) in two ways:
-By genetic mutation (a change in the micro-organisms’ DNA make-up) or
-By acquiring resistance from another micro-organism (through sharing of genetic material).
In bacteria, these genetic changes may produce antibiotic resistance by:
-Altering the antibiotic binding site on the bacterial surface
-Destroying the antibiotic with enzymes produced by the bacteria
-Preventing the antibiotic from entering the bacterial cell wall
-Pumping the antibiotic out of the bacterial cell as soon as it enters.

Question 30

How does the overuse of antibiotics encourage development of resistance?

Answer 30

Drug-susceptible (sensitive) bacteria are killed when an appropriate antibiotic is given at sufficient dose, frequency and duration.
If there are any bacteria resistant to the antibiotic, they can survive, multiply and replace the drug-susceptible bacteria.
Overuse of antibiotics (in humans and animals) creates ‘selective pressure’, selecting out drug-resistant strains. Misuse of antibiotics (e.g. underdosing or not completing a course of antibiotics) also selects out resistant bacteria.

Question 31

what is the primary goal of antimicrobial stewardship

Answer 31

To improve patient outcomes while minimising the adverse effects of antimicrobial use, such as the development of antimicrobial resistance.
To decrease the spread of multidrug resistant micro-organisms
Antimicrobial stewardship is any activity that promotes:
The use of antimicrobials only when indicated
The appropriate selection of antimicrobials
The appropriate dosing of antimicrobials
The appropriate route and duration of antimicrobial therapy.

Question 32

how is Antimicrobials misused?

Answer 32

Overuse: prolonged treatment with the same drug for resistant bacteria
Inappropriate use: unnecessary prescriptions of antibiotics for viral infections, e.g. the common cold, sore throats and influenza
Patient sharing of antibiotics without prescroiption
Underdosing: the use of a dose
or duration of treatment that does not result in bacterial killing,
but rather selects out drug-resistant strains, e.g. TB treatment defaulters.

Question 33

what is the consequences of misuse of antimicrobials

Answer 33

The negative, unintended consequences of antibiotic overuse or misuse are called ‘collateral damage’. These can include the following:
Drug-resistant micro-organisms develop
Fungal super-infection, e.g. candida infections occurs
Dangerous micro-organisms, e.g.Clostridium difficileinfections may not be treatable because of multi-drug resistance

Question 34

What is the role of the IPC practitioner in the antimicrobial stewardship programme?

Answer 34

Performing surveillance for resistant pathogens
Auditing hand hygiene compliance regularly
Ensuring healthcare staff perform cleaning and decontamination of patient care equipment such as bedpans, urinals and bowls
Ensuring appropriate isolation and transmission-based precautions are implemented
Ensuring thorough environmental cleaning is performed, especially for rooms where the prior occupant had a drug-resistant infection
Auditing IPC practices and healthcare-associated infection rates, with provision of feedback and support to clinical areas with poor performance
Encouraging healthcare workers to remove indwelling devices that are no longer needed, e.g. peripheral cannulae (drips), urinary catheters
Assisting with education and awareness programmes so that all clinical staff understand the importance of antimicrobial stewardship.

Question 35

Techniques or tools used for antimicrobial stewardship

Answer 35

Selective reporting
Antimicrobial consultation
Treatment de-escalation
Intravenous to oral switch
Therapeutic dose monitoring
Antimicrobial restriction
Antibiotic cycling
Antimicrobial guidelines
Antimicrobial prescription charts
Antimicrobial stewardship ward rounds.

Question 36

what is the difference between Narrow-spectrum versus a Broad-spectrum antibiotic

Answer 36

A narrow-spectrum antibiotic will treat only a limited number of pathogens, whereas a broad-spectrum antibiotic is effective against a wide variety of pathogens. The disadvantage of using a broad-spectrum antibiotic is that it encourages selection of drug-resistant pathogens, by killing off normal flora and other sensitive bacteria living in and on the patient.