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Infection control > Week 6: Laboratory Approaches > Flashcards

Week 6: Laboratory Approaches Flashcards

1
Q

Labs in Canada are licensed under what?

A

PHAC

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2
Q

In Canada, all facilities handling and storing human pathogens and toxins, such as public health labs, teaching and research labs, diagnostic labs in hospitals, and vaccine production plants are licensed under what?

A

-Human pathogens and Toxins Act (HPTA)
-Humans Pathogens and Toxins Regulations (HPTR)

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3
Q

containment (or biocontainment) is a combination of what?

A

physical design parameters and operational practices that protects the personnel, immediate work environment, the community, and the external environment from exposure to potentially hazardous biological material

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4
Q

how many containment levels are there?

A

4

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5
Q

Which containment level are most labs?

A

2 or 3

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6
Q

Describe CL1

A

biological material can be safety performed in a basic laboratory work area, large scale production area, or minimal work area

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7
Q

what microorganisms might a CL1 facility handle?

A

-bacillus subtilis
-non pathogenic E. coli

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8
Q

Which labs are often found in hospital settings?

A

CL2

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9
Q

which labs often have biosafety cabinets to protect from pathogen exposure?

A

CL2

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10
Q

Pathogens worked on in CL2 labs are mainly spread through ____ and ___

A

injection or ingestion

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11
Q

what are some examples of pathogens that would be handled in a CL2 lab?

A

-herpes
-E. coli
-Salmonella

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12
Q

What are some operational practices for CL2 labs?

A

-administrative (biosafety program management, safety)
-procedures (work practices, personal protective equipment, decontamination)

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13
Q

Which lab requires negative pressure with HEPA filtration for exhaust air?

A

CL3

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14
Q

What pathogens do CL3 labs handle?

A

-West Nile
-anthrax
-tuberculosis

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15
Q

True or false. In CL3 labs, the air is purified, scientists must take shower before exiting, and the waste is disinfected before leaving the facility?

A

True

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16
Q

With what containment level is the entire lab built with extra walls to prevent a potential breach (built as a box-within-a-box)

A

CL4

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17
Q

With what contaminate level do scientists work with a dedicated breathing air supply and take chemical showers to decontaminate their suits

A

CL4

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18
Q

CL4 labs have layers of what to ensure air always flows back into the lab when doors are open?

A

negative pressure zones

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19
Q

When Canada must prepare for deadly global outbreaks of pathogens like Ebola, Nipah virus, and Lassa fever, where is the research done?

A

CL4 labs

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20
Q

What organisms are tested at CL4 labs?

A

-Gonorrhea
-streptococcus
-TB
-E. coli
-Listeria
-Salmonella
-Shigella
-Measles
-Zika
-Rabies
-Ebola

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21
Q

How often are biological risk assessments completed?

A

annually

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22
Q

Define agent hazards

A

review potential biological agents and their hazardous characteristics including capability to infect and cause disease

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23
Q

What do lab procedures focus on??

A

focus on equipment and procedures that generate aerosols, use of sharps, etc

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24
Q

A risk assessment can be __ and involves what health department?

A

subjective; Occupational

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25
Q

define skill evaluation

A

evaluate expertise and proficiency of staff following safe procedures

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26
Q

Is the infectious nature usually known?

A

No, except in rare circumstances

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27
Q

initial processing of clinical specimens and serological identification of isolates can be done safely at what level?

A

CL2

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28
Q

BSC, PPE, or other physical contaminant devices must be used wen

A

a) procedures with potential for creating infectious aerosols or splashes are conducted
b)high concentrations or large volumes of infectious agents are used

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29
Q

The essential element for protection when transporting biohazardous materials is

A

triple-containment packaging

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30
Q

What type of swab would be used for an ARO?

A

-nasal
-rectal
-wound

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31
Q

how can specimens be collected?

A

-nasopharnygeal
-stool specimens
-blood collection
-CSF collection
-environmental swabs
-food collection

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32
Q

What are the 5 common criteria for MRSA/VRE screening?

A
  1. previous hospital admission (within 12 months)
  2. Any patient who has been admitted to a hospital outside of Canada in the last 12 months
  3. any patient who resides in a communal living setting
  4. any patient who has a previous MRSA/VRE infection or colonization history
  5. Patients admitted to ICU
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33
Q

nose swabs test for

A

MRSA

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34
Q

rectal swabs/stoma swabs test for

A

MRSA, or MRSA and VRE

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35
Q

stool cultures test for

A

MRSA, or MRSA and VRE

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36
Q

Draining a wound tests for

A

MRSA

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37
Q

True or false. Feces must be visible on the swab with a rectal swab

A

True

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38
Q

If there is more than one open wound, which one do you swab?

A

the one with the most drainage

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39
Q

when collecting urine from catheter collect from

A

tubing not the bag

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40
Q

how would you collect a specimen from a bedpan?

A

aspirate the specimen from the bedpan or clean the bedpan to prevent specimen contamination

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41
Q

Define a colony count

A

a pre-determined standard amount of urine is placed onto an agar plate using a calibrated loop and the number of colonies growing are counted

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42
Q

mulitple organisms (more than 3 different bacteria) suggests the specimen is what?

A

contaminated

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43
Q

stool collection should be collected in a manner than prevents contamination from what?

A

urine and water

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44
Q

do you need a large amount of stool for stool collection?

A

no. you need an amount the size of a raisin or until fluid level is raised to line on container. Stools produce gases so if you overfill the container can explode

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45
Q

You must make sure appropriate transportation media is used for tests required with stool collection. An example of this is

A

C. diff should be stored in a container with no media

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46
Q

When should stool collection be done?

A

-patient with one episode of vomitting and one loose stool in 24 hours
-two or more loose stools in a 24 hour period and (other critieria in notes)

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47
Q

stool for C. diff is tested for what?

A

toxin

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48
Q

specimens for C. diff collection must be

A

liquid stool

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49
Q

is culture done for C. diff?

A

no

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50
Q

How are stool specimens for C. diff tested?

A

two step lab screening and confirmatory test process
-screening: glutamte dehydrogenase antigen and toxins A/B with rapid enzyme immunoassay
-testing for C. diff toxin gene with a molecular LAMP assay

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51
Q

which lab reports don’t contain a susceptibility report?

A

pathogens that are self-limiting and don’t require treatment

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52
Q

lab reports that should contain a suscepibility report are for

A

pathogens that require treatment

53
Q

A negative lab report should include

A

what the specimen was examined for

54
Q

presence of ___ in any amount is significant

A

parasite

55
Q

a ___ culture requires special transport media obtained from the lab

A

viral culture

56
Q

travel and antibiotic history are important when

A

diarrhea is present

57
Q

throat swabs for culture are only significant for what m.o.?

A

group A strep

58
Q

why is no susceptibility report generated for Group A strep?

A

becuase it is considered universally sensitive

59
Q

how would you collect a throat swab?

A

have the patient open mouth wide and depress tongue with a tongue depressor. Gently swab mucosa behind uvula and between tonsils

60
Q

nasopharyngeal swab specimen should be stored and transported at what temp?

A

between 2-8 degrees celcus

61
Q

For a sputum collection, what specimens can be collected?

A

-sputum
-trachel aspirate
-bronchoalveolar lavage
-esophageal brushing
-lung tissue

62
Q

how much material do you want to collect for tracheal aspirates?

A

as much as possible

63
Q

when collecting bronchial washings, what should you avoid and why?

A

contaminating the bronchoscope with tap water as saprophytic mycobacteria may produce false-positive culture

64
Q

which specimens must you NOT freeze?s

A

sputum collection

65
Q

what are recommended specimens for MRSA?

A

-perianal
-skin lesions
-anterior nares

66
Q

What are the recommended specimens for VRE?

A

-stool/rectal anal swab (stool preferred)
-swabs from colostomy site if present

67
Q

with MRSA, the same swab can be used for what? different swabs must be used for what?

A

-same for both nares
-different for anal region and all wounds

68
Q

with VRE swab, swab around what area? Insert into rectum if there is no visible stool

A

external rectal orfice

69
Q

with what m.o. must you not collect specimens for microbiological examination before consulting with the PHO lab microbiologist?

A

Ebola

70
Q

What are some components of collecting wound specimen?

A

–the wound should be cleansed with saline to avoid contamination of the culture by surface organisms
-do not collect exudate or pus
-select the cleanest area of wound (firmly press and rotate the swab in this area)
-include tunnelling if present

71
Q

which microorganism requires the initiation of the Emergency Response Assistance Plan, special shipping and handling?

A

Ebola

72
Q

specimens for malaria testing collected from suspected or confirmed VHF cases are subject to part 7 of what?

A

the Transport Canada Transportation of Dangerous Goods regulation

73
Q

When should viral hemorrhagic fever like Ebola be suspected?

A

in patients with fever and relevant travel history to endemic exposure areas within 21 days of illness onset?

74
Q

During the collection procedure, the specimen container must be labelled with what information?

A

the patients full name, date of collection, and one other unique identifier such as the patients date of birth or health card number

75
Q

when reporting an injury to the Occupational Health Department, the medical provider’s description of the injury should include what information?

A

-the potential infectious agent
-the mechanism and route of exposure
-time and place of the incident
-PPE used at the time of event
-First aid provided
-Department supervisor, witness

76
Q

What are examples of environmental specimens that can be collected?

A

-water
-sewage
-air
-ultrasound gels
-sink/P trao
-birthing tubs

77
Q

how should results be interpreted?

A

based on the patient’s clinical presentation, risk factors, and exposure history

78
Q

define accuracy

A

the closeness of the result obtained to the true value and is described by two terms

79
Q

who two terms define accuracy?

A

specificity and sensitivity

80
Q

Define sensitivity

A

Detect all true cases of the disease, or the absence of false-negative results. Sensitivity is the number of true-positive results over the number of true positive plus false negative results

81
Q

Both sensitivity and specificty and ___ and expressed as ___

A

proportions; percentage

82
Q

define specificity

A

the number of true negative results over the number of true negatives plus false positive results

83
Q

define precision

A

repeat testing on the same sample consistently provides the same or similar results

84
Q

what is screening used to do?

A

identify a disease without signs or symptoms in large patient populations

85
Q

screening tests have high ___ but low ___

A

sensitivity but low specificity

86
Q

A definitive diagnosis can be given by detecting an immunological response. What type of reaction is this?

A

Ag-Ab specific to the infecting agent in the patient’s serum

87
Q

antigens are usually __ or ___

A

proteins or polysaccharides

88
Q

what do antigens do?

A

stimulate the immune system to produce antibodies such as immunoglobulins

89
Q

Does antigen detection directly identify the presence of infectious agents?

A

Yes

90
Q

what are examples of antigen detection tests?

A

-agglutination tests
-immunofluorescence
-enzyme linked immunosorbent assay (ELISA)

91
Q

what are some microorganisms detected by antigen?

A

-HIV
-streptococcus pneumoniae
-Neisseria meningitidis
-group B streptococcus
-Cryptococcus spp
-Hep B envelop
-Hep B surface
-Legionella
-COVID-19

92
Q

antibody or immunoglobulin are a product of what?

A

acquired immunity

93
Q

what produces antibodies?

A

B lymphocytes

94
Q

What are 4 types of diagnostic tests?

A
  1. antibody detection
  2. antigen detection
  3. molecular diagnostic testing
  4. tests for infectious process
95
Q

Antibodies attach to a specific

A

antigen

96
Q

antibody tests can be used to detect what agents?

A

-chlamydia
-Hep A
-Hep B envelop
-Hep B surface
-Hep B core
-Giardia
-helicobacterpylori

97
Q

True or false. All molecular tests can read as false positive due to possible sample contamination

A

True

98
Q

What are 3 types of molecular diagnostic tests?

A
  1. Target Amplification Methods
  2. Probe Amplification Methods
  3. Signal Amplification Methods
99
Q

Describe tests for infectious processes

A

body fluid obtained using sterile technique

100
Q

When is cerebrospinal fluid collected?

A

when meningitis is suspected

101
Q

Cloudy CSF indicates

A

bacterial infection

102
Q

clear or hazy CSF indicates

A

viral or fungal infection

103
Q

What is CSF analyzed for?

A

color and clarity, protein, glucose, and WBC (including differential)

104
Q

what can body fluid be analyzed for?

A

-total protein
-specific gravity
-cell count
-different (types of WBC present)
-body fluid glucose
-gram stain
-culture

105
Q

E. Coli and Klebsiella that are resistant to carbapenems should be presumed

A

carbapenemase producers until proven otherwise

106
Q

True or false. Some gram-negative bacteria may be resistant to carbapenems by other means (not producing carbapenamese)

A

True

107
Q

Which bacteria are resistant to carbapenems without producing carbapenemase?

A

-Proteus and Providencia spp.
-Enterbacter
-Acinetobacter
-pseudomonas

108
Q

True or false. Specimens with a single target detected will be reported as COVID-19

A

virus detected

109
Q

when is a test reported as invalid?

A

-results on uninterpretable (usually due to failed detection of assay control)
-CT values

110
Q

What is the positive predictive value of a PCR test?

A

close to 100%

111
Q

A positive result for Hep A IgG (in the absence of Hep A IgM) indicates

A

immunity to Hep A virus

112
Q

A positive result for Hep A IgM with or without a positive Hep A IgG suggests

A

recent/acute infection with Hep A

113
Q

Hep B surface antigen (HBsAG) indicates

A

that the person is infectious

114
Q

HBsAG can be detected in high levels during

A

acute or chronic Hep B virus infection

115
Q

Hep B surface antibody (anti-HBs)

A

indicates recovery and immunity from Hep B infection (or someone vaccinated against Hep B)

116
Q

Total Hep B core antibody (anti-HBc)

A

appears at the onset of symptoms in acute Hep B and persists for life

117
Q

the presence of anti-HBc indicates

A

previous or ongoing infection with hep B virus in an undefined time frame

118
Q

IgM antibody to Hep B core antigen (IgM anti-HBc) indicates

A

positivity indicates recent infection with Hep B virus

119
Q

What specimen types can be collected for measles?

A

-nasopharyngeal swab
-throat swab
-urine
-CSF

120
Q

How much urine and how much CSF must be collected for measles testing?

A

50ml; 1ml

121
Q

What are the 4 specimen collection methods for pulmonary TB?

A
  1. sputum induction
  2. bronchoscopy
  3. coughing
  4. gastric aspiration
122
Q

describe how an AFB test is classified for TB

A

according to the number of acid-fast bacilli seen, the smears are classified as 4+, 3+, 2+, or 1+

123
Q

Can TB be detected by culture?

A

Yes

124
Q

What is the current gold standard for detection of active TB disease?

A

mycobacterial culture

125
Q

what is the most senstiive test for detecting active TB?

A

mycobacterial culture

126
Q

True or false. A single-definitive culture for M. tuberculosis is considered definitive for active disease

A

True

127
Q

True or false. Every specimen that is sent for smear microscopy is submitted for culture

A

True

128
Q

Describe nucleic acid amplification tests (NAAT)

A

the amplification of nucleic acids for the diagnosis of TB or to detect drug resistance is a sensitive method faster than culture methods

Infection control (7 decks)

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