Week 1: Isolation Flashcards
What is asepsis?
Process for keeping away disease-producing microorganisms.
2 types of asepsis:
Medical asepsis + Surgical asepsis
What is the main difference between disinfection and sterilization?
Disinfection - elimination of pathogens except for bacterial spores.
Sterilization - including spores.
What is the key difference between critical items, semicritical items, and noncritical items when it comes to disinfecting/sterilization? Give examples of each:
Critical - instruments enter sterile tissue or the vascular system. Example: surgical instruments, an intravascular catheter (IV line), urinary catheters, needles.
Semi-critical - devices that come in contact with mucous membranes or nonintact skin but do not penetrate them. Example: thermometers, resp therapy equipment, endotracheal tubes, GI endoscopes, vaginal and nasal specula.
Non-critical - items that touch only skin (not mucous membranes) or do not directly touch the patient. Example: bedpans, urinals, commodes, BP cuffs, linens, stethoscopes, eating utensils.
What are the 3 categories of additional (isolation) precautions (tier two)?
Contact
Airborne
Droplet
What are the 2 tiers of precations
1st tier - routine practices
2nd tier - additional precautions (isolation - 3 categories)
What distinguishes a contact precaution from a droplet or airborne precaution?
Contact: direct/indirect
Droplet: > 5 microns
Airborne: < 5 or equal to microns
Droplet precautions are used for which infectious agents? Give examples of diseases that are transmitted by droplets.
Infectious agents: > 5 microns (transmitted by droplets produced by coughing, sneezing, or talking)
Eg. influenza, covid19, diphtheria (pharyngeal), rubella, pertussis, mumps, meningococcal pneumonia, sepsis
Airborne precautions are used for which infectious agents? Give examples of diseases that are transmitted airborne.
Infectious agents: < 5 or equal to microns.
Ex. measles, chickenpox (varicella), disseminated zoster, TB
Contact precautions are used for which infectious agents? Give examples of diseases that are transmitted by contact.
Infectious agents transmitted via direct or in-direct contact.
Ex. MRSA, VRE, bed bugs, wound infections, clostridium difficile, norovirus, CPO & CPE (drug-resistant organisms)
For an airborne precaution, what barrier protections are implemented?
- single room: negative pressure, the DOOR CLOSED, vented to the outside or special filter.
- everyone wears an N95 mask (taken ff outside the room)
- pt only our for essential procedures (wears a mask)
For a droplet precaution, what barrier protections are implemented?
- single room or cohort patients; DOOR CAN BE OPEN.
- cohort patients 2 M apart, the door only open if bed 2 M apart from the door
- gloves, gown, MASKS, and EYEWEAR must be worn
- pt only our for essential procedures (wears a mask)
For a contact precaution, what barrier protections are implemented?
- single room or cohort pts.
- DOOR MAY BE OPEN
- gown/glove if direct contact
- dedicated equipment or disinfect after use
For a contact plus precaution, what barrier protections are implemented?
- single room or cohort pts.
- DOOR MAY BE OPEN
- gown/glove if direct contact
- dedicated equipment or disinfect after use
- must wear mask/eye-protection if pt vomiting, coughing, etc.
- enhanced housekeeping procedures
For an enhanced contact precaution, what barrier protections are implemented?
- SINGLE ROOM
- gloves/gown for ALL entries
- dedicated equipment, limited transport of pt
- dedicated nursing required
- enhanced housekeeping procedures
List the 3 different contact precaution types and diseases for each:
Contact precautions (MRSA, VRE, bed bugs, wound infections)
Plus contact precautions (Cdiff, norovirus)
Enhanced contact precautions (CPO & CPE (drug-resistant organisms))
What purpose do isolation precautions serve and when are they intended?
They are designed to contain pathogens in one area (usually pt’s room), and they are only for those with highly transmissible or epidemiologically significant pathogens.
Good to know:
List the adverse effects of isolation (from isolation precautions)?
- psychological consequences (depression, anxiety, anger, hostility, loneliness, neglect, and low self-esteem).
- physiological decline (falls, malnutrition, pressure injuries, fluid/electrolyte imbalances).
- inattention from health care (longer to answer the call bell, lack of explanations, and less time being spent with the pts, RESULTING in increased incontinence).
- decreased physio/OT/recreational therapy
What entails PPE?
Gloves (non-sterile)
Facial protection (mask (procedural/N95)
Gown
Shoe & hair covers prn
Briefly explain the purpose of each PPE item:
Gloves
Mask
N95 mask
Gown
Gloves: prevent transmission of pathogens by direct and indirect contact. Must be changed between tasks. Hand hygiene is a MUST after removal.
Mask: Pathogens cannot enter the mouth or nose. Must be snug. Keep talking to a minimum when transporting pts to reduce respiratory airflow.
N95 masks: Airborne diseases (TB, measles, herpes zoster)
Gown: Prevents contamination of clothes and protects health care workers and visitors from coming in contact with infected material, blood, or body fluid.
Define infection:
physiological ATTACK from microorganisms on body tissues and systems.
Define immunity:
the physiological REACTION to an antigen. The state of being insusceptible to specific diseases.
What are the 2 core isolation principles?
- to contain pathogens
2. to protect pts, visitors, and health care workers
Define microorganism
a microscopic organism, especially a bacterium, virus, or fungus.
Define pathogen
a bacterium, virus, or another microorganism that can cause disease.
Define infection
The invasion and growth of germs in the body. The germs may be bacteria, viruses, yeast, fungi, or other microorganisms
Define nosocomial
A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital.
Define virulence
The severity or harmfulness of a disease
Define colonization
The presence of bacteria on a body surface (like on the skin, mouth, intestines or airway) without causing disease in the person.
Define epidemiology
Epidemiological studies measure the risk of illness or death in an exposed population compared to that risk in an identical, unexposed population (for example, a population of the same age, sex, race, and social status as the exposed population).
What does ARO’s stand for?
Antibiotic-resistant organisms
What does MDRO’s stand for?
multiple drug-resistant organisms
What does MRSA stand for?
Methicillin-resistant staphylococcus aureus
What does VRE stand for?
Vancomycin-resistant enterococci
What does CDAD stand for?
clostridium difficile associated diarrhea
What does HAI’s stand for?
hospital-acquired infections
What does CAUTI’s stand for?
catheter-associated UTI’s
What does AGMP stand for?
aerosol-generating medical procedure
List the modes of transmission of disease (5)
Contact - direct/ndirect
Droplet > 5 microns
Airborne < or equal to 5 microns
Vehicle transmission - when substances such as soil, water, or air carry the pathogens to a new host.
Vector transmission - infections by the bite of an infected arthropod species such as mosquitoes, ticks, etc.
Briefly explain 1st tier of precautions:
- routine precautions (designed for all pts)
- handwashing
- PPEs (gloves, gown, eyewear) if contact with blood or body fluids
- linen, sharps, equipment disposal to prevent illnesses/infections
Briefly explain 2nd tier of precautions:
ISOLATION precautions: contact, contact plus, enhanced contact, droplet, airborne, and cytotoxic precautions (for immunocompromised pts)
- PPE and barrier protection as per specific precaution.
What additional steps are taken for immunocompromised pts (chemo pts, post-transplant, HIV/AIDs)
- 4 moments of hand hygiene
- PPE per point of care risk assessment
- restrict visitors
- dedicated pt equipment
- single room if possible
- must not be placed with pts who are risk factors for transmission (tubes, wounds, etc)
What does donning PPE mean?
Putting “on”
What does doffing PPE mean?
Taking “off”
List the steps to donning PPE?
- Hand hygiene
- Gown
- Mask (procedural/N95)
- eyewear
- gloves over cuffs
List the steps to doffing PPE:
- Remove gloves & discard
- Hand hygiene (optional)
- Remove gown & discard
- Hand hygiene
- Remove eyewear, then mask
- Hang hygiene
List the steps to doffing PPE if wearing N95 (precaution rooms):
- Remove gloves & discard
- Hand hygiene
- Remove gown & discard
- Hand hygiene
- Exit to hallway or anteroom
- Remove eyewear
- Hand hygiene
- Remove N95 by straps then discard
- Hand hygiene
If a negative pressure room is not available to do an AGP (aerosol-generating procedure), then what extra step should be taken?
Placing an AGP signage on pt’s door and leaving it there (with the door closed) for 1 hour after the procedure
If an N95 mask if required (droplet or AIrborne), where should it be removed?
Always outside the room
What must any staff members delivering or collecting trays from a patient with droplet precautions do?
Don PPE
What PPE is required for AGP’s?
N95
Face shield or goggles
Gown
Gloves
