ATI Infection Control
Which of the following is an advantage of using alcohol-based gel? -its use takes less time than washing w/ soap and water does -it removes gross contamination better than soap and water does -its protective nature reduces the need for frequent handwashing -it provides adequate protection before surgical applications
A During an 8-hour shift, an estimated 1 hr of an ICU nurse's time is saved by handrubbing with an alcohol-based gel
Which of the following precaution interventions are appropriate for this patient? A) Private room B) Dedicated or disposable equipment C) A mask worn when within 3 ft. of the patient D) Hospital gowns, gloves, and masks for visitors
A and B A private room is an appropriate component of contact precautions because it helps minimize cross-contamination Dedicated or disposable equipment is an appropriate component of contact precautions because it helps minimize cross-contamination
Which components of standard precautions are required in this case? A) Wash hands after patient contact B) Wear clean disposable gloves when handling the patient's emesis basin C) Place emesis-soiled linen on the floor, well away from the patient and any visitors.
A and B Handwashing is considered the most effective way to prevent the spread of microorganisms Standard precautions require the use of clean, nonsterile gloves whenever there is actual or potential touching of body fluids, blood, secretions, excretions, or any object that is might be contaminated with such materials.
A nurse and a personal care assistant are making rounds at the beginning of their shift. Prior to entering the patient's room, they must select the appropriate personal protective equipment (PPE). Which of the following are appropriate for this patient based on the prior assessment? A) Gloves B) Surgical mask C) Gown D) N95 respiratory
A and D Gloves are appropriate because of this patient's productive cough with hemoptysis and yellow sputum. An N95 respirator protects healthcare workers from droplet nuclei smaller than 5 microns, such as TB
HISTORY: The patient states, "I feel really sick. I'm going to throw up," and then projectile vomits approximately 150 mL of green emesis that appears to be blood-tinged into an emesis basin and onto his shirt. Considering the previous history, what information is vital to determining how the staff should protect themselves? A) The patient is experiencing projectile vomiting B) He is alert and able to use an emesis basin C) His vital signs do no support the presence of an infective process D) His emesis appears to be blood-tinged
A and D Projectile vomiting forcefully transports body fluid and any infectious microorganisms it may contain out into the environment where it has the added potential for cross-contamination of other people and objects. The presence of blood in vomitus adds another infectious component to body fluid
Methicillin-resistant Staphylococcus aureus (MRSA)
A bacterium that causes infections in different parts of the body and is often resistant to commonly used antibiotics; can be found on the skin, in surgical wounds, in the bloodstream, lungs, and urinary tract.
To decontaminate your hands with an alcohol-based gel, you rub them together until all of the gel has evaporated and your hands are dry. The primary reason you do this is that -drying provides the full antiseptic effect -residual alcohol can easily stain clothing -excess gel could transfer to the patient -slippery gel can make you drop supplies
A dry environment offers better protection against the proliferation of pathogens than a moist environment does.
You are about to irrigate a patient's open wound. Besides gloves, which other item of personal protective equipment (PPE) must you wear? a sterile gown goggles a face shield An N95 respirator
A face shield A face shield protects the face, mouth, nose and eyes from any potential splashes of blood or other body fluids. Irrigating a would certainly has the potential for splashing irrigating fluid containing blood, body fluids, and tissue particle onto your face.
standard precautions
A strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.
HISTORY Both the nurse and the ED technician quickly don personal protective equipment (PPE) before continuing to provide care to the patient. Which of the following PPE are appropriate to use when caring for this patient? A) Single-use, disposable gown B) Disposable mask C) Surgical gloves D) Goggles
A, B, and D This is appropriate for standard precautions when the potential for contact with bloody body fluids is significant. This is appropriate for standard precautions when the potential for contact with bloody body fluids projected out into the environment is significant, as it is with projectile vomiting. This situation poses a risk for the transfer of microorganisms through the mucous membranes of the mouth and the nose. These are appropriate for standard precautions when the potential for contact with bloody body fluids projected out into the environment is significant, as it is with projectile vomiting. This situation poses a risk for the transfer of microorganisms through the mucous membranes of the eye.
How long can influenza viruses survive outside a host?
At room temperature, with moderate humidity, these viruses can live 24 to 48 hours on steel and plastic, and 8 to 12 hours on cloth and facial tissues.
After assisting a newly admitted patient in removing his shoes and outerwear, you notice what appears to be soil or grime on your hands. You -cleanse your hands w/ an alcohol-based gel -wash your hands w/ soap and water -brush off the soil against a cloth surface -use a wet paper towel to remove the soil
B CDC recommends washing w/ soap and water whenever hands are visibly dirty.
Should the nurse have said anything to the ED technician about his decision not to wear goggles when caring for this patient? A) No, it is a personal decision to wear PPE while caring for a patient. B) Yes, the nurse is responsible for educating the ED technician about the need for the goggles.
B It is established policy to implement standard precautions when caring for any patient. This patient's projectile vomiting clearly warranted the use of disposable gloves, a gown, a mask, and goggles. It was a nursing responsibility to remind the ED technician of this policy as well as the ineffectiveness of his glasses as a substitute for goggles.
retrovirus
An RNA virus that reproduces by transcribing its RNA into DNA and then inserting the DNA into a cellular chromosome; an important class of cancer-causing viruses.
HISTORY: Here's your challenge. Your patient is a 69-year-old woman who came to the emergency department reporting a persistent productive cough for 3 weeks. She also reports night sweats, fever, chills, and profound fatigue. She is admitted to your unit with tuberculosis. ASSESSMENT: Vital signs: temperature 101.8, pulse 88, respiratory rate 22, BP 124/68. Breath sounds with rales bilaterally. Productive cough with yellow sputum and hemoptysis noted. Reports chills, fatigue, and a history of night sweats. Does a diagnosis of tuberculosis require any infection control measures? No Yes
B Tuberculosis requires isolation, which is a part infection control standards. Standard precautions are also indicated when healthcare workers anticipate coming in contact with blood and body fluids. This client has a productive cough with yellow sputum and hemoptysis.
The nurse is reviewing the plan of care for this patient. Which of the following interventions are appropriate for this patient? A) Semiprivate room B) Negative-airflow room C) N95 respirator D) Surgical asepsis
B and C A patient who has tuberculosis requires a negative airflow room with HEPA filtration of at least 6 to 12 exchanges per hour. An N95 respirator protects healthcare workers from droplet nuclei smaller than 5 microns.
The Centers for Disease Control and Prevention (CDC) issued isolation guidelines in 2007 that use a two-tiered approach. The first tier is standard precautions. The second tier involves isolation precautions. Which type of precautions should be instituted for this patient to prevent the spread of tuberculosis? A) Contact precautions B) Airborne precautions C) Droplet precautions
B- CORRECT Airborne precautions are required to prevent the spread of tuberculosis. TB is spread through droplet nuclei smaller than 5 microns.
Which is the most likely portal of exit of this patient? a) Respiratory tract b) Gastrointestinal tract c) Urinary tract
B. Gastrointestinal tract The most likely infectious substances are the patient's stool and vomitus
Standard precautions mandate A) rinsing gloves that become visibly soiled during use B) using antimicrobial soap for routine handwashing C) disinfecting hands immediately after removing gloves D) keeping gloves on when touching environmental surfaces
C) Although it might seem as though hands covered by intact gloves would be as clean as they were when you donned the gloves, it is essential component of standard precautions to disinfect your hands immediately after glove removal. This often concludes a patient-care procedure, and hand hygiene is mandated between patient contacts. Also, you cannot assume that the integrity of each glove has not been breached, that no powder or other residue remains on your hands, and that your hands have not contaminated during glove removal.
Which product can affect the permeability of gloves? antimicrobial soap and water alcohol-based antiseptic gel petroleum-based hand lotion water-based hand lotion
C Can impair the integrity of latex gloves, weakening them and increasing their permeability
HISTORY: An intravenous (IV) line is inserted and the prescribed IV fluids infusion is started. A stool culture confirms the presence of Salmonella bacteria. While the patient continues to have diarrhea, he has it less frequently. Taking into consideration all the above history and assessment data, select all the precautions you must use when providing care for this patient. A) Airborne precautions B) Droplet precautions C) Contact precautions D) Standard precautions
C- Contact precautions These precautions are appropriate for organisms that are transmitted by coming into direct contact with an infected patient or an infected item. D- Standard precautions These precautions are used for the care of all hospitalized patients regardless of their actual or potential infection status.
transmission-based precautions
CDC precautions used in patients known or suspected to be infected with pathogens that can be transmitted by airborne, droplet, or contact routes; used in addition to standard precautions
infection
Contamination or invasion of body tissue by pathogenic organisms
sepsis
Dangerous infection of the blood
HISTORY: The ED technician opts not to use eye protectors (goggles) since he already wears eyeglasses. Was this an appropriate decision on the part of the ED technician? No Yes
Glasses do not provide adequate eye protection and are not an acceptable for of PPE
droplet precautions
Methods of infection control that must be used for patients known or suspected to be infected with pathogens transmitted by large particle droplets expelled during coughing, sneezing, talking, or laughing.
How far can a virus-laden droplet travel and still be a potential source of infection?
It can travel up to 3 ft in any direction and still be infectious
exogenous
Produced outside the body
How can I protect elderly clients and other immunocompromised clients from health care associated infections?
Standard precautions should be used with all patients to prevent the spread of pathogens.
antiseptic
a substance that reduces the number of pathogens present on a surface
antibody
a type of protein the immune system produces to neutralize a threat of some kind, such as an infecting organism, a chemical, or some other foreign body
HISTORY Your patient is a 26-year-old male who arrived at the emergency department (ED) with reports of nausea and vomiting over the past 24 hours. ASSESSMENT Vital signs: Temperature = 36.8° C (98.2° F), Blood pressure = 124/76, Pulse = 88, Respiratory rate = 16. The patient reports abdominal fullness and burning pain in his upper abdomen that he rates as 7 out of 10 on a pain scale. He says that he has been "drinking a lot" since losing his job 4 months ago. He is to be admitted to rule out gastritis. Do you have any concerns about infection control for this patient? No Yes
YES You should be concerned. While standard precautions are used in the care of all hospitalized patients, a history of vomiting is of particular concern because it makes direct contact with the patient's body fluids especially likely
HISTORY: Your patient is a 74-year-old male who was seen in the emergency department (ED) where he reported nausea, severe abdominal cramping, and diarrhea for the past couple of days. He was admitted to your unit with a diagnosis of dehydration. Vital signs: Temperature = 38.4° C (101.2° F), Blood pressure = 114/76, Pulse = 104, Respiratory rate = 16. The patient reports weakness and syncope, especially when standing. His skin turgor is fair, while his oral mucous membranes appear pale and dry. The patient experienced a cerebrovascular accident 2 years ago that has left him with left-sided paralysis. He requires assistance to reposition in bed, to transfer to a chair, and to perform self-hygiene care. The patient reports, "The last thing I ate before the diarrhea started was a salad with grilled chicken." Do you have any concerns about infection control for this patient? Yes No
Yes - You should be concerned. Vomiting and diarrhea are often the result of an infectious process, and the patient has signs of infection and dehydration: elevated temperature, tachycardia, poor skin turgor, altered oral mucous membranes, and orthostatic hypotension
HISTORY: You enter the room in full protective garb, adjust the patient's IV fluid infusion, provide him with a bedpan, reposition him after providing peri-care, empty and clean the bedpan, document the care you provide in the notebook, and move 10 feet away to the sink. You remove and dispose of all personal protective equipment. After appropriate handwashing, you pick up both the notebook and the pen, place them onto the designated counter, and then leave the room. Within 3 days, five patients and 14 staff members have infectious diarrhea. Considering the previous information, where did you fail to maintain appropriate technique to prevent contact transmission of the Salmonella bacteria in this patient's stool?
You should have re-washed your hands after touching the contaminated notebook and pen. Preferred procedure would have been to document care only AFTER removing your PPE and performing effective handwashing to avoid contaminating the notebook and the pen.
Staphylococcus
a genus of gram-positive bacteria that are potential pathogens, causing local lesions and serious opportunistic infections
latex
a milky fluid produced by rubber trees that is processed into a variety of products, including gloves used for patient care
antimoicrobial
able to destroy or suppress the growth of pathogens and other micro-organisms
A patient has a healthcare-associated infection (HAI). This terminology means that the patient -became infected due to comprised immunity -was infected during a therapeutic procedure -inhaled pathogens in a healthcare setting -acquired the infection while hospitalized
acquired the infection while hospitalized
Latex allergy
allergic reaction to natural rubber latex
Chemical-sensitivity dermatitis
an allergic contact dermatitis Symptoms: begin 24-48 hrs after contact, similar to those cause by poison ivy. Cause by: chemicals added to latex during harvesting, processing, or manufacturing.
chlorhexidine
an antibacterial compound with substantial residual activity that is used as a liquid antiseptic and disinfectant
disinfectant
any chemical agent used to destroy or inhibit the growth of harmful organisms
aseptic
as pathogen-free as possible
flora
bacteria, fungi, and other micro-organisms normally found in the particular environment, the gastrointestinal tract or the skin
You are washing your hands with a nonantimicrobial soap and water prior to repositioning a patient in bed. During the hand washing procedure, it is important to -make sure that the water is hot -continue for at least 15 seconds -use a liquid soap preparation -remove rings and watches first
continue for at least 15 seconds reduces bacterial counts and can remove loosely transient flora. CDC recommends rubbing hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
epidemic
extremely prevalent or widespread
After completing a procedure that required donning PPE consisting of a gown, an N95 respirator, a face shield, and gloves, which of the following should the nurse remove first when removing PPE separately? The gloves The gown The face shield The N95 respirator
gloves Gloves are considered the most contaminated and should be removed first, followed by face/eye protection, gown and mask/respirator.
immunosuppression
impaired ability to provide an immune response
Contact precautions would be mandated for a hospitalized adult patient diagnosed with hepatitis B measles meningitis infectious diarrhea
infectious diarrhea contact precautions are essential for preventing the spread of certain enteric infections. These precautions mean no direct touching of the patient, the environment, the equipment, or the supplies used. The patient should be in a private room.
contact precautions
measures taken to prevent the spread of diseases transmitted by the physical transfer of pathogens to a susceptible host's body surface
airborne precautions
measures taken to prevent the spread of diseases transmitted from an infected person by pathogens propelled through the air on particles smaller than 5 µm in size to a susceptible person's eyes, nose, or mouth
asepsis
methods used to assure that an environment is as pathogen-free as possible
hyperendemic
persistent, high levels of disease occurrence
pneumococcal
pertaining to or caused by pneumococci, organisms of the species Streptococcus pneumoniae, a common cause of pneumonia and other infectious diseases
medical asepsis
practices designed to reduce the number and transfer of pathogens; basic handwashing
endemic
prevalent in or characteristic of a particular environment
endogenous
produced within an organism or system rather than externally caused
You are caring for a patient diagnosed with mycoplasmal pneumonia. Droplet precautions have been instituted, so you must -wear a respirator -protect your eyes -use an air filter -wear shoe covers
protect your eyes droplet transmission involves contact of infectious, large-particle droplets w/ the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person. Droplets are generated by the patient during coughing, sneezing, or talking, and during procedures such as suctioning and bronchoscopy
Irritant contact dermatitis
rubber latex. Affects the hands, become dry, itchy, and irritated. This is caused by irritation from using gloves and exposure to workplace products and chemicals. Can also result from repeated hand-washing and drying, incomplete hand drying, use of cleaners and sanitzers, and exposure to powdered gloves. Is not a true allergy.
surgical asepsis
sterile technique
bacteriostasis
the inhibition of further bacterial growth
contamination
the process of becoming unsterile or unclean
isolation
the separation of an infected person from others for the period of communicability of a particular disease
vancomycin-resistant Staphylococcus aureus (VRSA)
type of S. aureus organism resistant to the antibiotic vancomycin
pathogen
virus, bacterium, or fungus. a disease-producing agent
