Infection Control

An effective alcohol-based hand scrub must contain at least ____ percent alcohol.

Answer: An effective alcohol-based hand scrub must contain at least 60% percent alcohol.

A patient infected with which pathogen cannot be treated with antibiotics because the infectious agent has a protective envelope? Bacterium Virus Fungi Parasite

Answer: Virus

A microorganism is considered to be resistant if it cannot be stopped by the use of ___ or more antibiotics.

Answer: 2 or more antibiotics

Portal of Entry

The infectious agent must gain entry into the new host for successful transmission. A portal of entry is the means by which the infectious agent achieves entry to a susceptible host. Portals of entry are similar to portals of exit, including the respiratory tract, gastrointestinal tract, genitourinary tract, blood, and breaks in the skin or mucous membranes. Portals of entry are usually the first colonized by infectious agents.

Which step is first in the sequence for donning personal protective equipment (PPE)? Hand hygiene Head cover Mask Gown

Answer: o Hand hygiene Explanation: o Hand hygiene Hand hygiene is the first in the sequence of steps for donning PPE. It is also the last after removing PPE. · o Head cover The head cover is donned fourth in the sequence of donning PPE. o Mask The mask is donned third in the sequence of donning PPE. · o Gown The gown, if needed, is donned second in the sequence of donning PPE.

Which action did the nurse recognize as a breach in surgical asepsis that contaminated the sterile field? Provider touched sterile field one-half inch from edge Provider reached over sterile field to pick up a towel Masked assistant talked over the sterile field Sterile packages opened facing away from body

Answer: Provider reached over sterile field to pick up a towel

Suctioning allows entry of infectious agents into which portal of entry? Respiratory tract Bloodstream Upper gastrointestinal (GI) tract Mucous membranes

Answer: Respiratory tract Explanation: Respiratory tract Suctioning can facilitate the entry of infectious agents into the respiratory tract. Use of contaminated equipment can also promote colonization of pathogenic organisms. Bloodstream Suctioning permits infectious agents to enter the lungs, but not the bloodstream. Upper gastrointestinal (GI) tract Suctioning permits infectious agents to enter the lungs. Material from the mouth before and after suctioning can enter the upper GI tract, but digestive enzymes and pH are protective there. Mucous membranes Suctioning, if done incorrectly, can disrupt mucous membranes, but they contain protective enzymes that kill infectious agents.

Overview Health care-associated infections (HAIs) are infections acquired by patients while receiving treatment for other conditions within the health care setting. These settings include inpatient acute care hospitals, outpatient settings such as ambulatory surgical centers and end-stage renal disease facilities, and long-term care facilities such as nursing homes and rehabilitation centers. Many HAIs are preventable, yet they contribute to morbidity (infection and disease) and mortality (death) every year (Magil, 2014). Common hospital-associated infections are: Catheter-associated urinary tract infections (CAUTIs) Pneumonia and ventilator-associated pneumonia (VAP) Injection site infections Surgical site infections Central line-associated bloodstream infections (CLABSIs) Gastrointestinal infections from Clostridium difficile

Risk Factors Many factors can contribute to the development of HAIs including: Use of Medical Devices Indwelling urinary catheters Intravenous catheters Ventilators Ineffective Cleaning Lax or ineffective use of handwashing or standard precautions Improper use or reuse of hospital equipment Improper cleaning or disinfecting of health care environment, especially between patients Transmission of Contagious Material Contact by patient or health care workers with blood-borne pathogens through contaminated blood or body fluids Patient Vulnerability Complications after surgical procedures Overuse or incorrect use of antibiotics Patients with multiple comorbidities, such as diabetes mellitus, chronic heart failure or other chronic illnesses, compromised immune system

Standard Precautions

Standard precautions are the minimum infection prevention practices implemented for all patients in any setting where patient care is delivered, regardless of whether or not the patient has an infection or suspected infection. Standard precautions include: Hand hygiene Use of personal protective equipment (e.g., gloves, gowns, masks), as needed Safe injection practices Safe handling of potentially contaminated equipment or surfaces in the patient environment Respiratory hygiene/cough etiquette

Transmission Based Precaution Types Transmission-based precautions are the second type of precautions implemented, along with standard precautions, for patients who are infected or colonized with certain highly contagious infectious agents, such as tuberculosis. Transmission-based precautions include contact, droplet, and airborne. Contact Precautions Droplet Precautions Airborne Precautions

Contact precautions are implemented to prevent transmission of known or suspected infectious agents directly or indirectly from one patient or person to another. Contact transmission of pathogens can occur through:Direct contact with the patientIndirect contact with equipment or items in the patient's environment Precautions include: Single patient room or cohorting of patients with similar risk factors (e.g., stool incontinence, same infection) if a single room is not available. PPE use upon entry into room and discarding upon exit to contain pathogens.Gloves when touching the patient and the patient's immediate environment or belongings.Gown if substantial contact with the patient or their environment is anticipated (CDC, 2015). Conditions for which contact precautions are required: Multidrug-resistant organisms (MDROs), including vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Clostridium difficile, respiratory syncytial virus, and hepatitis A Scabies and herpes simplex virus (HSV) Excessive wound drainage Fecal incontinence with potential for environmental contamination and risk for transmission. Droplet precautions are implemented for patients who are known, or suspected, to be infected with an infectious pathogen that can be transmitted by respiratory droplets. Droplet transmission of pathogens can occur through:Coughing, sneezing, talking, suctioning, endotracheal intubation, cardiopulmonary resuscitation (CPR), or chest physiotherapy Precautions include: Protocol per institution policy. Patient is placed in a single patient room with a closed door as soon as possible, prioritizing patients with excessive cough and sputum production. If a private room is not available, the patient is provided with a facemask and placed in a separate area as far from other patients as possible. PPE use:Facemask, such as a procedure or surgical mask, for close contact with the patient; the facemask is donned upon entering the patient's room.If substantial spraying of respiratory fluids is anticipated, gloves, gown, and goggles (or face shield in place of goggles) are worn. Patient wears a facemask when exiting the room and follows respiratory hygiene/cough etiquette. Conditions for which droplet precautions are required: Pharyngeal diphtheria Mumps, rubella, and pertussis Streptococcal pharyngitis and scarlet fever Pneumonias (streptococcal, mycoplasma, meningococcal) Pneumonic plague Meningococcal sepsis Influenza Airborne Precautions include: Protocol per institution policy. Patients enter through a separate entrance to the facility, if available, to avoid the reception and registration area. Patient immediately placed in an airborne infection isolation room (AIIR). PPE use:A fit-tested N95 or higher-level disposable respirator when caring for the patient. The respirator is donned before room entry and removed after exiting room.Gown, gloves, and goggles or face shield are worn if substantial spraying of respiratory fluids is anticipated. Patient wears a facemask when exiting the room, avoiding close contact with other patients, and practicing respiratory hygiene/cough etiquette (CDC, 2015). Conditions for which droplet precautions are required: Varicella or disseminated varicella zoster (chickenpox) Rubeola (measles) Mycobacterium tuberculosis (pulmonary or laryngeal tuberculosis)

Mode of Transmission Once the infectious agent finds a portal of exit and leaves the host, it must find a way to travel from the source (reservoir) to the next susceptible host. The transportation process is called the mode of transmission and occurs by three different methods: contact, vehicle, and vector transmission. Contact Transmission Vehicle Transmission Vector-Borne Transmission Previous

: Contact Transmission: Direct contact is the physical transfer of microorganism (pathogens) from between hosts. For example, between the infected individual directly to a susceptible host through kissing, touching, sexual contact, or fecal-oral contact. Indirect contact is the transfer of microorganisms between hosts by means of an inanimate object, called a fomite. For example, a fomite can be a dressing, medical equipment or supplies, clothing, toys, diapers, money, dishes, contaminated needles, or air.Airborne transmission occurs when air serves as the transmission vehicle. Microorganisms are dispersed by air currents that travel greater than one meter and are inhaled or deposited on the skin of a susceptible host. Tuberculosis, measles, and chickenpox can be transmitted through air conditioning and cooling systems, forceful coughing, and pathogens attached to dust particles, sweeping, and by changing bed linens.Droplets are infectious agents transferred by small respiratory beads (droplets) from infected host to susceptible host through coughing, sneezing, laughing, or simply by exhaling. Influenza and respiratory syncytial virus (RSV) are transmitted via droplets (CDC, 2018). Vehicle Transmission: Vehicle transmission occurs primarily by: > Waterborne/foodborne transmission occurs when water or food serve as the transmission vehicle. Pathogens are transmitted to the susceptible host when water is contaminated by untreated sewage or food is contaminated with feces. Salmonella, hepatitis A, and Escherichia coli are examples of pathogens that are transmitted by contaminated food and/or water. Depending on the pathogen, standard precautions, or standard plus other specific transmission precautions may be required for these patients. Vector-Borne Transmission: Vectors carry pathogens from one host to the next susceptible host. Standard precautions are used for patients infected with pathogens transmitted by vectors. Biological vectors participate in the pathogen's life cycle and transmit disease. These vectors can be animals or insects. For example, ticks carry Lyme disease. Mosquitoes carry West Nile, malaria, yellow fever, and viral encephalitis. Lice carry epidemic typhus. Each of these passes the pathogens along to susceptible hosts when they bite the host. Mechanical vectors passively pass the pathogen from host to the next susceptible host. They do not participate in the pathogen's life cycle, but are capable of passing the pathogen passively along. Examples include the common housefly contaminating food causing dysentery and intestinal worms, and cockroaches causing the foodborne disease giardiasis through food contamination.

Microbial resistance is caused by which phenomenon? Microorganisms adapting to their environment Infectious agents developing greater virulence Pathogens changing replication patterns Bacteria developing protective outer coats

A nswer: Microorganisms adapting to their environment Explanation: Microorganisms adapting to their environment Microorganisms adapt to their environment to compete for survival. This phenomenon is known as drug resistance or microbial resistance. Infectious agents developing greater virulence Virulence refers to the ability of the infectious agents to cause disease. It does not address the phenomenon of microbial resistance. Pathogens changing replication patterns Pathogens may change replication patterns, but that is not the underlying phenomenon resulting in microbial resistance. Bacteria developing protective outer coats Viruses, not bacteria, have protective envelopes known as outer coats.

Environmental Medical Asepsis

Additional medical aseptic interventions that break the chain of infection and protect the susceptible host include environmental safeguards and the nurse protecting self and others. Environmental Safeguards Cleaning and maintaining cleanliness of the patient environment is part of medical asepsis. It facilitates the removal of organic and inorganic material and breaks the chain of infection by interrupting the transmission of infectious agents. Discard disposable items in proper receptacles (e.g., items contaminated with bloodborne pathogens may be discarded in biohazard bags depending on the amount of blood requiring disposal). Clean from less soiled to more soiled areas to avoid increasing contamination. Place items that are moist from body fluids in the appropriate receptacle immediately. Wrap heavily soiled items in plastic to prevent direct contact with the substance by others. Pour liquids (e.g., bath water, mouthwash) directly into the drain to avoid splashing. Avoid allowing soiled items, such as linens, to touch clothing to decrease the chance of spreading infectious material to other patients. Keep soiled items off the floor to decrease the chance of contamination. Avoid shaking linens to decrease the chance of infectious particles becoming airborne. Remove clutter from patient's room.

Hand hygiene is the most important medical aseptic technique performed by nurses and all other health care providers. It protects patients, self, and others from infection because it breaks the chain of infection by interrupting the transmission of infectious agents. Hand hygiene includes hand washing with soap and water, the use of an alcohol-based sanitizer, or use of a surgical hand scrub before surgery or some invasive procedures.

Alcohol-based hand sanitizers quickly reduce the number of microbes but do not eliminate all types of pathogens. They are effective for reducing microorganisms on health care worker hands when:hands are not visibly dirtythey contain at least 60% alcohol. Soap and water is the best way to reduce the number of hand microorganisms:when the hands are visibly dirty after known or suspected exposure to Clostridium difficile or exposure to patients with infectious diarrhea from norovirusbefore eatingafter toileting (CDC, 2018). Non-alcohol-based hand sanitizers reduce growth of microorganisms but do not kill them. Additionally, they do not reduce growth of microorganisms, such as gram-positive vs. gram-negative bacteria, cryptosporidium, and norovirus.Non-alcohol-based sanitizers are more likely to irritate skin than alcohol-based hand sanitizers. They may cause microorganisms to develop resistance to the sanitizing agent.

A patient with which infection will be admitted to the airborne infection isolation room? Pharyngeal diphtheria Meningococcal sepsis Staphylococcus aureus Varicella zoster

Answer: Varicella zoster Explanation: o Pharyngeal diphtheria This pathogen causes diphtheria. Droplet precautions are required but not an airborne infection isolation room. · o Meningococcal sepsis This pathogen causes meningitis. Droplet precautions are required but not an airborne infection isolation room. · o Staphylococcus aureus This pathogen causes types of infections. Contact precautions are required but not an airborne infection isolation room. · Correct o Varicella zoster This pathogen causes chickenpox. It is highly contagious and requires admitting the patient to an airborne infection isolation room.

During which encounters is a patient at risk for acquiring health care-associated infections (HAIs)? Select all that apply. Dialysis treatment Outpatient surgery Provider office visit Rehabilitation session Neighborhood pharmacy

Answer(s): Dialysis treatment Outpatient surgery Provider office visit Rehabilitation session Explanation: Dialysis treatment Patients receiving dialysis are at risk for acquiring HAIs caused by the possibility of contaminated equipment or intravenous site for dialysis. Outpatient surgery Patients receiving care in outpatient surgery centers are at risk for acquiring HAIs resulting from contact with other patients and the potential for surgical instrument and surgical site contamination. Provider office visit Patients receiving care from their provider at the office are at risk for acquiring HAIs because of close contact with other patients who might be ill while waiting to see their provider and the potential for lax cleaning of rooms between patients. Rehabilitation session Patients receiving care for rehabilitation are at risk for acquiring HAIs as a result of their contact with other patients and health care professionals. Neighborhood pharmacy The patient is not likely to acquire an HAI when visiting a neighborhood pharmacy. However, the patient might be at risk for a community-acquired infection if other pharmacy visitors do not practice handwashing or respiratory etiquette.

Place in order the steps of establishing a sterile field. Don a facemask if required. Establish the sterile field above waist level. Open sterile pack away from the body. Perform thorough hand hygiene. Do not turn away from the sterile field.

Answer: Don a facemask if required. Perform thorough hand hygiene. Establish the sterile field above waist level. Open sterile pack away from the body. Do not turn away from the sterile field. Setting up and maintaining a sterile field proceeds from gathering supplies to actually setting up and staying within the sterile field.

Which home care intervention helps reduce the transmission of infections? Reporting infections as early as recognized Using disposable dishes and utensils Soaking clothing in bleach solution Isolating the infected individual from others

Answer: Reporting infections as early as recognized Explanation: Reporting infections as early as recognized Reporting signs of infection early is an intervention that helps reduce the transmission of infections in the home. Treatment or precautions can be implemented to reduce transmission. Using disposable dishes and utensils This is expensive and unnecessary. Cleaning reusable equipment and supplies at home with soap and water and disinfecting with 10% chlorine saves money and prevents transmission of microorganisms. Soaking clothing in bleach solution Soaking clothing in bleach can ruin clothing and is unnecessary. Personal items should not be shared, but otherwise, clothing should be washed in hot soap and water as usual. Isolating the infected individual from others The infected person does not need to be isolated unless ordered by the health care provider, state, or federal agencies. Implementing infection control practices at home are adequate for controlling infections under ordinary circumstances.

The nurse has been splashed in the face with body fluids. In what order will the nurse respond? Report exposure to immediate supervisor. Irrigate eyes with clean water or saline if available. Flush splashed areas to the nose and mouth with water. Wash exposed skin, cuts, and needlestick injuries.

Answer: Wash exposed skin, cuts, and needlestick injuries. Flush splashed areas to the nose and mouth with water. Irrigate eyes with clean water or saline if available. Report exposure to immediate supervisor. Exactly!

By which means are pathogens transmitted through droplets and require infected patients to be placed on protective precautions? Select all that apply. Coughing Sneezing Suctioning Eating Talking

Answer: Coughing Sneezing Suctioning Talking Explanation: Coughing Coughing is a means by which pathogens are transmitted by droplets, which is why droplet precautions are implemented. Sneezing Sneezing is a means by which pathogens are transmitted by droplets, which is why droplet precautions are implemented. Suctioning Suctioning is a means by which pathogens are transmitted by droplets, which is why droplet precautions are implemented. Eating Eating is not a means by which pathogens are transmitted. However, eating utensils are contaminated and must be thoroughly cleaned or disposable utensils used. Talking Talking is a means by which pathogens are transmitted by droplets, which is why droplet precautions are implemented.

A health care-associated infection (HAI) may be acquired under which circumstance? A treatment is received for another condition in the health care setting. A health care provider prescribed the incorrect treatment or medication. A complication from a treatment or medication develops that could have been avoided. An infection fails to respond to treatment or at least two different antibiotics.

Answer: A treatment is received for another condition in the health care setting. Explanation: A treatment is received for another condition in the health cAsare setting. This describes an HAI. When a patient develops an infection while receiving care for another condition within a health care setting, it is a health care-associated infection. HAIs are infections acquired by patients while receiving treatment for other conditions within the health care setting. A health care provider prescribed the incorrect treatment or medication. This incident describes either negligence or malpractice on the part of the provider, which is a legal matter. It is not a HAI. A complication from a treatment or medication develops that could have been avoided. Complications from treatments or medications are side effects, toxic effects, or complications. They are not HAIs. An infection fails to respond to treatment or at least two different antibiotics. Failure to respond to treatment or at least two different antibiotics describes drug or antibiotic resistance, not HAIs.

Which infection control issue contributes to antimicrobial resistance? Congested health settings Patient noncompliance People in urban centers Lack of patient education

Answer: Congested health settings Explanation: Congested health settings An infection control issue is that of overcrowding of hospitals and clinics where both infected and well persons are exposed to other infected persons, and thus, pathogens. Patient noncompliance Patient noncompliance does contribute to drug resistance; however, it is not an infection control issue. People in urban centers People in urban centers alone is not an infection control issue. Lack of sanitation and/or hygiene within urban centers is the infection control issue. Lack of patient education Lack of patient education does contribute to drug resistance; however, it is not an infection control issue.

A patient with the respiratory infection influenza contracted the pathogen by which mode of transmission? Direct contact Droplet Biological Airborne NOT SURE

Answer: Droplet Explanation: Direct contact Direct contact is the physical transfer of microorganisms (pathogens) from between hosts through kissing, touching, etc. Droplet Droplets are infectious agents transferred by small respiratory droplets from infected host to susceptible host through coughing, sneezing, laughing, or simply by exhaling. Influenza is transmitted by droplets. Biological Biological vectors participate in the pathogen's life cycle and transmit disease. Lyme disease carried by ticks is an example of a biological vector. Airborne Airborne transmission occurs when air serves as the transmission vehicle. Microorganisms are dispersed by air currents that travel greater than one meter and are inhaled or deposited on the skin of a susceptible host. Tuberculosis is transmitted by this method.

Communities can help reduce infections among their citizens by engaging in which actions? Encouraging and facilitating immunization programs Providing containers for used needle disposal to patients Assisting with health care environment modifications Educating patients about home infection control measures

Answer: Encouraging and facilitating immunization programs Explanation: o Encouraging and facilitating immunization programs Communities can be active in helping reduce infections by encouraging its citizens to get immunizations, and facilitating immunization programs and clinics. · o Providing containers for used needle disposal to patients Communities are not responsible for providing individual patients with containers for needle disposal. This is a home care action. · o Assisting with health care environment modifications Communities are not responsible for health care environment modifications. This is an action for each facility or agency. · Incorrect o Educating patients about home infection control measures Communities do not educate patients about home infection control measures. This is a home care action.

The nurse will implement contact precautions when learning that a patient is being admitted with which infection? Hepatitis A Streptococcal pneumonia Influenza Chickenpox

Answer: Hep A Explanation: o Hepatitis A Hepatitis A is transmitted by direct contact from person to person. The nurse will implement contact precautions. · o Streptococcal pneumonia The nurse will implement droplet precautions for the patient with streptococcal pneumonia. · o Influenza The nurse will implement droplet precautions for the patient with influenza. o Chickenpox The nurse will implement airborne precautions for the patient with chickenpox.

Which personal protective equipment (PPE) will the nurse don before observing a sterile procedure in the emergency department? Mask Gown Hair cover Sterile gloves

Answer: Mask Explanation: Mask The nurse will don a mask because of closely observing the procedure. Respiratory droplets can travel 3 feet or more, contaminating the sterile field. Gown A gown is not necessary because the nurse should be observing the procedure and not participating at the sterile field. Hair cover A hair cover is not necessary because the nurse should not be standing at the sterile field. Sterile gloves Sterile gloves are not required because the nurse is not participating in the procedure or standing at the sterile field.

Which component of the chain of infection involves the infectious agent leaving the reservoir? Source Portal of entry Portal of exit Mode of transmission

Answer: Portal of exit Explanation: Source The source is the reservoir. It can be human, animal, or inanimate. Reservoirs harbor microorganisms and provide nourishment for survival. Portal of entry The portal of entry is where the microorganism enters the body. This may include the respiratory, gastrointestinal, genitourinary tracts, or through the skin/mucous membranes. Portal of exit The portal of exit is where the infectious agent leaves the host and spreads to other people. Coughing, sneezing, and blowing one's nose are examples. Mode of transmission The mode of transmission is the way in which the microorganism is transmitted from one host to the next, which may be by air, droplets, or direct contact with the host.

As a member of the infection control committee, which action can the nurse suggest to help control transmission of respiratory infections among staff during influenza season? Role model wearing gloves during patient care. Speak to peers about obtaining their immunizations. Teach hand hygiene to unlicensed assistive personnel. Post signs in bathrooms demonstrating cough etiquette. NOT SURE

Answer: Post signs in bathrooms demonstrating cough etiquette. Explanation: Role model wearing gloves during patient care. Role modeling is a positive action; however, wearing gloves is a part of standard precautions. This is not likely to help control the transmission of respiratory infections among staff. Speak to peers about obtaining their immunizations. This action might be perceived as judgmental or intrusive. Some facilities have policies regarding immunizations. Also, immunizations for influenza must be administered several weeks before exposure to the virus to be effective. Teach hand hygiene to unlicensed assistive personnel. Unlicensed assistive personnel are required to know how to perform hand hygiene. This is a redundant action. Post signs in bathrooms demonstrating cough etiquette. This is a good suggestion and could be very effective. All nurses and many visitors go into bathrooms and can easily see signs that catch their attention.

Which statement describes medical asepsis? Absence of all infectious agents Procedure known as clean technique Requires use of sterile gloves Prevents microbial entry into body

Answer: Procedure known as clean technique Explanation: Absence of all infectious agents This statement describes asepsis, which means the complete absence of all disease-producing microorganisms. Procedure known as clean technique Medical asepsis is also known as clean technique and includes hand washing to prevent the spread of microorganisms. Requires use of sterile gloves Surgical asepsis, not medical asepsis, requires the use of sterile gloves. Clean gloves are used when employing medical asepsis. Prevents microbial entry into body Surgical asepsis, not medical asepsis, is used to prevent entry of microorganisms into the body from the environment.

Which medical asepsis interventions by the nurse protect the patient from infection? Select all that apply. Cleaning patient bedside equipment routinely Disposing of used needles in sharps containers Placing items wet from body fluids in biohazard bags Providing leak-proof receptacles at bedside for tissues Preventing contamination of intravenous sites and ports Removing excess linens from the patient's room

Answers: Cleaning patient bedside equipment routinely Disposing of used needles in sharps containers Providing leak-proof receptacles at bedside for tissues Preventing contamination of intravenous sites and ports

Which transmission-based precaution will the nurse take for a seriously ill patient being admitted for influenza? Avoid admitting through the reception area. Admit to an airborne infection isolation room. Obtain an N95 disposable respirator mask. Provide a mask for patient if leaving the room.

Answer: Provide a mask for patient if leaving the room. Explanation: Avoid admitting through the reception area. Avoiding admittance through the reception area is not necessary for a patient with influenza. This precaution applies to patients on airborne precautions, such as tuberculosis. Admit to an airborne infection isolation room. Admittance to an airborne infection isolation room is not necessary for a patient with influenza. This precaution applies to patients on airborne precautions, such as tuberculosis. Obtain an N95 disposable respirator mask. Obtaining an N95 disposable respirator mask is not necessary for a patient with influenza. This precaution applies to patients on airborne precautions, such as tuberculosis. Provide a mask for patient if leaving the room. Providing a mask for the patient if leaving the room is a precaution that applies to patients with influenza on droplet precautions. A single room with the door closed is desired; the patient must wear a mask if they leave the room to protect other patients and staff. Previous

Which statement is correct regarding hand hygiene in the health care setting? Soap and water effectively reduce microorganisms on visibly dirty hands. Infectious agents are killed when using soap and water for washing hands. Washing hands with very hot water helps eliminate a greater number of bacteria. Non-alcohol-based hand sanitizers inhibit microorganism growth on hands.

Answer: Soap and water effectively reduce microorganisms on visibly dirty hands. Explanation: Soap and water effectively reduce microorganisms on visibly dirty hands. Hand washing breaks the chain of infection by interrupting microorganism transmission. Washing with soap and water effectively removes, and thus reduces, microorganisms on the skin when hands are visibly dirty. Infectious agents are killed when using soap and water for washing hands. Hand washing with soap and water does not kill infectious agents. It does eliminate their presence and reduces the risk for infection. Washing hands with very hot water helps eliminate a greater number of bacteria. Hand washing does not need to be performed with very hot water to be effective. In fact, hot water can damage the skin and prevent future hygiene. Non-alcohol-based hand sanitizers inhibit microorganism growth on hands. Non-alcohol-based hand sanitizers do not inhibit the growth of or kill microorganisms. They do reduce the growth of some microorganisms but not bacteria, such as cryptosporidium or norovirus, when used for cleaning hands. Previous

Equipment being used to enter a sterile body cavity must undergo which procedure? · o Sanitization Sanitization means to clean and disinfect. Sanitizing includes cleaning and use of disinfecting agents such as chlorhexidine, which is not sufficient to clean instruments entering sterile body cavities. · o Disinfection Disinfection with agents such as chlorhexidine is not sufficient to clean instruments entering sterile body cavities. · Correct o Sterilization Any item that will be used to enter a sterile body cavity must be thoroughly cleaned and sterilized before use. · o Decontamination Decontamination is required before use, but it is not sufficient. Another procedure is required before instruments can be used to enter a sterile body cavity.

Answer: Sterilization Explanation: Sanitization Explanations: o Disinfection Disinfection with agents such as chlorhexidine is not sufficient to clean instruments entering sterile body cavities. o Sterilization Any item that will be used to enter a sterile body cavity must be thoroughly cleaned and sterilized before use. · o Decontamination Decontamination is required before use, but it is not sufficient. Another procedure is required before instruments can be used to enter a sterile body cavity.

Which is the best source for the nurse to recommend to patients interested in information about the updated immunization schedule for adults? Their health care provider's clinic or office The Centers for Disease Control and Prevention's (CDC's) immunization website Any health care provider at a local pharmacy The US government website

Answer: The Centers for Disease Control and Prevention's (CDC's) immunization website Explanation: Their health care provider's clinic or office It is possible that not all providers have a copy of the latest adult immunization schedule. This is a good source but not the best source for this information. The Centers for Disease Control and Prevention's (CDC's) immunization website This is the best source for information about immunization schedules for children and adults. It is constantly updated. Any health care provider at a local pharmacy Pharmacy providers may or may not have current schedules. This might be a good source, but it is not the best source for this information. The US government website This is not a specific website. There are many US government websites. This is not helpful information.

The nurse will don a fitted N95 respiratory mask when caring for a patient with which infection? Tuberculosis Influenza Pneumonia Nares methicillin-resistant Staphylococcus aureus (MRSA)

Answer: Tuberculosis Explanation: o Tuberculosis Tuberculosis is a disease transmitted through small droplet nuclei and must be countered with airborne precautions, which involves the use of an N95 respirator mask. · o Influenza Influenza is transmitted through large droplets. The patient should be placed on droplet precautions, not mandating the use of an N95 respirator. · o Pneumonia Pneumonia is also transmitted through large droplets. The patient should be placed on droplet precautions. An N95 mask is not necessary. · o Nares methicillin-resistant Staphylococcus aureus (MRSA) MRSA is transmitted through direct contact. The patient should be placed on contact precautions. A respirator mask is not necessary.

Which precautions will the nurse take when handling needles (sharps) to prevent an accidental needlestick? Recapping the needle after use Using a needleless system whenever possible Placing covered intravenous (IV) cannula securely in trash Flushing needles with water before disposing of them

Answer: Using a needleless system whenever possible Explanation: Recapping the needle after use Needles must never be recapped. Recapping can result in the injury to the nurse from a contaminated needle and future infection. Using a needleless system whenever possible The use of needleless systems should always be used whenever possible to avoid accidental needlesticks from either clean or contaminated needles. Placing covered intravenous (IV) cannula securely in trash Contaminated needles, including IV cannulas, must never be placed in the trash. They are disposed of in a sharps container, the same as sharps, or in a biohazard container because they have blood on them. Flushing needles with water before disposing of them Needles do not need to be flushed prior to disposal. Doing so places the nurse at risk for a needlestick.

Which activities can a nurse easily participate in if interested in slowing infection transmission within the community? Select all that apply. Closing schools during influenza pandemics Changing employer policies regarding sick leave Participating in local hand-washing campaigns Working locally to encourage immunizations Avoiding mass gatherings during flu season

Answers: Participating in local hand-washing campaigns Working locally to encourage immunizations Closing schools during influenza pandemics This is an important community action; however, it is not an activity in which a nurse can easily participate. Changing employer policies regarding sick leave This is an important community action; however, it is not one in which nurses can easily participate unless they can join a committee and work toward changing policies where they work. Participating in local hand-washing campaigns This is an activity in which nurses can easily participate in their local communities if they are interested and motivated. This is an important activity. Working locally to encourage immunizations This is an activity in which nurses can easily participate in their local communities if they are interested and motivated. This is an important activity. Avoiding mass gatherings during flu season This is a very important activity; however, it is a personal, not a community, activity.

The Centers for Disease Control and Prevention (CDC) applies the term quarantine to which group(s)? Select all that apply. People Animals Cargo Buildings Institutions

Answers: People Animals Cargo Buildings Explanation: People The CDC quarantine can apply to any person who is suspected of being exposed to an infectious disease. Animals The CDC applies the term quarantine to more than just people. It also applies to animals that may carry an infection or have been exposed to an infectious agent. Cargo Cargo that is suspected of containing infectious material can be quarantined. Buildings Buildings where infectious material may be stored or found can be quarantined. Institutions Institutions are agencies or organizations, such as the CDC itself. It cannot be quarantined.

What are purposes of hand hygiene? Select all that apply. Prevents the spread of infection Breaks the chain of infection Interrupts organism transmission Enhances the patient relationship Kills microorganisms

Answers: Prevents the spread of infection Breaks the chain of infection Interrupts organism transmission Explanation: Prevents the spread of infection Hand hygiene prevents the spread of infection by preventing the spread of microorganisms. It is the most important medical aseptic technique performed by nurses and other health care providers. Breaks the chain of infection Hand hygiene does break the chain of infection by preventing the spread of microorganisms. It is the most important medical aseptic technique performed by nurses and other health care providers. Interrupts organism transmission Hand hygiene does interrupt the mode of transmission of organisms, including microorganisms, thus preventing potential infections. It is the most important medical aseptic technique performed by nurses and other health care providers. · Enhances the patient relationship Seeing nurses wash their hands does enhance the patient relationship because it gives patients confidence in the care they are receiving. However, it is not the purpose for hand hygiene. · Kills microorganisms Hand hygiene reduces the growth of microorganisms but does not kill them.

The nurse understands that standard precautions includes which practices? Select all that apply. Hand hygiene Cough etiquette Patient cleanliness Safe injection practices Use of personal protective equipment (PPE)

Answers: Hand hygiene Cough etiquette Safe injection practices Use of personal protective equipment (PPE) Explanation: Hand hygiene Standard precautions are the minimum practices needed to prevent transmission of infection. Hand hygiene is the most important means for reducing transmission of microorganisms. Cough etiquette Cough etiquette is an important part of standard precautions to prevent the spread of respiratory infections. Patient cleanliness Patient cleanliness (hygiene) is very important in breaking the chain of infection, but it is not a part of standard precautions. Safe injection practices Safe injection practices are an important part of standard precautions, including safe injection practices and disposal of contaminated injection equipment. Use of personal protective equipment (PPE) Regular and proper use of PPE is part of standard precautions to prevent the spread of infections.

Which actions are required by the nurse when preparing for a sterile procedure? Select all that apply. Keeping sterile surfaces dry Setting up the sterile field Leaving the room for supplies Checking packaging integrity Monitoring activities of others Delegating preparations to unlicensed assistive personnel (UAP)

Answers: Keeping sterile surfaces dry Setting up the sterile field Checking packaging integrity Monitoring activities of others

Which action to reduce the spread of infections is the nursing taking by avoiding going to work when sick? Personal Community Home Employee

Answers: Personal Explanation: o Personal The nurse staying home is a personal action taken to help reduce the transmission of infection to other staff members and patients. · o Community Community actions are broad actions taken by groups within the community. Nurses can participate in some of these activities. · o Home Home actions include teaching patients how to prevent infections at home. · o Employee Employee actions include those that pertain to abiding by policies and procedures pertaining to health and illness.

Infectious Agent Infectious agents are the first link in the chain of infection. Any infectious agent that causes disease is referred to as a pathogen. Pathogens have varying degrees of ability to cause disease. This property is called pathogenicity or virulence. For example, when influenza causes severe illness in adults and children, it is often considered a virulent strain of influenza. Pathogens include bacteria, viruses, fungi, and parasites.

Bacteria: Single-cell organisms May be opportunistic, causing disease when the immune system is compromised Different sizes, shapes, growth patterns Reproduce by dividing one cell into two identical cells Identified by culturing a sample taken from the body Undergo testing to determine sensitivity to exact antibiotics to ensure effective antibiotics are prescribed May live as normal flora on and in the skin, eyes, nose, mouth, upper throat, lower urethra, lower intestine, and large intestine. Viruses: Microscopic infectious agents Reproduce inside living cells of the host Responsible for causing many different types of disease Responsible for illnesses ranging from the common cold to human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) Protective envelope cannot be destroyed by antibiotics Managed with certain antiviral medications used to control symptoms and decrease the length of illness if given during the early phases of illness. Fungi: Single-cell organisms Include molds and yeast Found in air, soil, and water Responsible for conditions such as athlete's foot, ringworm, and yeast infections Treated with antifungal medications Parasites: Organisms that benefit from or live on other organisms Protozoa, helminths, and arthropods are primarily pathogenic to humans: Protozoa cause malariaHelminths cause intestinal worms Arthropods cause skin and systemic diseases Transmitted by sexual contact, insects, and domestic animals Parasites are treated with anthelminthic, antimalarial, and antiparasitic agents

Match the transmission-based precaution with the mode of transmission it prevents. Contact Droplet Airborne Animal vector Suspended particles Coughing, sneezing Food or water Person to person

ContactPerson to person DropletCoughing, sneezing AirborneSuspended particles

Match the infectious agent to its description. Different sizes, shapes, and growth patterns Cannot be killed by antibiotics Found in air, soil, and water Transmitted by insects and domestic animals Prions Parasites Bacter Viruses Fungi NOT SURE

Different sizes, shapes, and growth patterns = Bacteria Cannot be killed by antibiotics = Viruses Found in air, soil, and water = Fungi Transmitted by insects and domestic animals = Parasites Prions

Which statements best describe the purpose for greeting the patient and explaining the need for personal protective equipment (PPE)? Select all that apply. Eases fear and misunderstanding Creates a professional relationship Builds a trusting relationship Fulfills legal requirements Eliminates later confusion NOT SURE

Eases fear and misunderstanding Creates a professional relationship Builds a trusting relationship

Which piece of personal protective equipment (PPE) will the nurse consistently don when anticipating that contact with the patient's body secretions will be possible? Gloves Masks Eyewear Gown

Gloves Gloves are always worn during patient encounters in which the nurse anticipates that direct contact with body secretions are possible or will occur. Masks Masks are not necessary unless there is a risk of microorganisms being spread through droplets or airborne transmission. Eyewear Eyewear is not necessary equipment unless there is a risk of body fluids splashing into the nurse's eyes. Gown A gown is not needed unless there is a high risk of the nurse's clothes being splashed or contaminated by body fluids.

Personal protective equipment (PPE) is the equipment that health care personnel use to protect against the spread of infection. Some examples of PPE are gloves, masks, goggles, face shields, isolation gowns, head covers, and shoe covers. Proper use of PPE is essential to stop the spread of microorganisms.

Gowns: Gowns are not worn when practicing standard precautions. Isolation gowns are worn when there is a possibility that clothing will become soiled. They are used only once and are discarded or cleaned after each use. Masks: Masks protect against the transmission of infectious agents through the air. Masks protect against large particles that travel only a short distance (less than 3 feet) and small particles that can remain suspended in the air and can travel much farther. The effectiveness of masks is decreased when they get wet or are worn for long periods. Special particulate respirators (e.g., N95 masks) are used when a patient has, or is suspected of having, a contagious airborne disease, such as tuberculosis. N95 masks require medical evaluation and measurement for the wearer before using the respirator and they must be fit-tested by the facility. Goggles and Face Shields: Eye and face gear is designed to protect the wearer against a variety of hazards. Goggles provide reliable eye protection from splashes, sprays, and respiratory droplets. However, goggles do not provide protection to other parts of the face. Face shields provide protection for facial areas. A face shield should have crown and chin protection and wrap around the face to the point of the ear, which reduces the likelihood that a splash could go around the edge of the shield and reach the eyes (CDC, 2015). Head and Shoe Covers: Head covers are used to cover hair, and shoe covers are used to protect the shoes. Head and shoe covers are used in areas where there is a high risk for contamination of the patient, nurse, or provider, such as in the operating room or labor and delivery areas. Gloves: lean, nonsterile gloves are used when direct contact with body secretions is possible. Sterile gloves are needed during sterile procedures, such as urinary catheter insertion. Gloves decrease the risk of transferring organisms from one individual to another. Gloves are changed if they become soiled and are always changed between patients.

Hand hygiene i

Hand hygiene is the most important means of reducing the transmission of infectious agents (microorganisms) to patients and preventing the risk for health care personnel from becoming infected or colonized with microorganisms from patients. Hand hygiene, as part of standard precautions, is practiced during routine patient care: Before and after working with an individual patient. Before and after any procedure involving patient contact. Before applying and after removing gloves. Hand washing is indicated when hands are visibly soiled. When hands are not visibly soiled, alcohol-based hand sanitizer may be used. Before eating. After using the restroom. Safe injection practices are also an important aspect of standard precautions. When using sharps (needles)Discard needles in sharps container, including discontinued intravenous (IV) cannulas.Use safety needles.Use needleless systems when possible.Never recap used needles.

Home Care

Home Care Infection prevention in the home environment involves educating patients and their families or caregivers about the mode of transmission of pathogens and the means of prevention. Many aseptic procedures that are performed in the health care environment can be performed in the home with some modifications. The nurse must know what these modifications are and how to teach patients and their families/caregivers the necessary skills before discharge. To minimize the risk for infection in the home, teach the patient and caregiver to:Perform hand hygiene before handling foods, before eating, after toileting, before and after required home care treatments, and after touching body substances such as wound drainage.Avoid sharing personal care items, such as toothbrushes, washcloths, and towels.Clean reusable equipment and supplies with soap and water, and disinfect with 10% chlorine bleach solution.Avoid coughing, sneezing, or breathing directly on others; use tissues and dispose of them in moisture-proof plastic bags.Maintain current immunizations.Recognize signs and symptoms of infection and report them as soon as recognized.Know when to contact a health care provider. Teach patients with wound care:Signs of wound healing and wound infections.When to report signs that indicate nonhealing or may indicate infection.Correct technique for changing dressings and disposing of soiled dressings.The need for placing contaminated dressings and other disposable items containing body fluids in moisture-proof plastic bags. Teach patients requiring self-injections:Place used needles in a puncture-resistant container with a screw-top lid and label the container so that it can be safely discarded. The patient and caregiver need to repeat instructions and demonstrate skills to ensure understanding and ability to perform skills correctly.

Immunizations

Immunizations can be acquired through vaccination. Immunizations are important for preventing the spread of communicable infections within a community. Immunization is the process by which an individual develops active immunity against a specific agent. Immunizations can be acquired through various techniques, the most common of which is vaccination. While immunizations are an individual responsibility, communities can encourage and facilitate immunization programs. Immunizations provided by vaccination protect an individual against a particular communicable disease, such as measles. Although vaccine-preventable diseases are at an all-time low, in some areas of the United States, children, adolescents, and adults remain underimmunized. There are several reasons for under-utilization of immunizations: Relying on herd immunity and seeing no reason to be vaccinated. Herd immunity is a form of indirect protection provided by a large population who have been immunized, thereby affording some protection to persons who have not been immunized. This, however, leaves the nonimmunized individuals vulnerable to disease. Conflicts with religious, cultural, or personal beliefs. Lack of knowledge about the benefit of immunizations. Beliefs that contracting the disease provides better disease protection than vaccines. This is particularly risky because diseases such as measles, mumps, and other contagious diseases can have serious consequences such as pneumonia, encephalitis, or death. Vaccine refusal by individuals who believe vaccines are toxic, leading to pockets of outbreaks of measles and mumps in the United States (Smith, 2017). The CDC has recommended schedules for immunizations for children and adults on their website, and this information is regularly updated. Nurses must remain vigilant about educating patients about immunization schedules and the benefits immunizations, and dispel myths about immunizations, to decrease the spread of preventable contagious diseases within the community.

Respiratory Hygiene, Etiquette, and Documentation

In 2007, Siegel et al. added respiratory etiquette to standard precautions, which are now part of the Centers for Disease Control and Prevention (CDC) standard precaution guidelines (CDC, 2012). The goal was, and is, to prevent the transmission of all respiratory infections in health care settings, including influenza. Respiratory Hygiene and Etiquette Respiratory hygiene/etiquette for persons with signs and symptoms of a respiratory infection, including patients, staff, and visitors includes: Covering the mouth and nose with a tissue, if available, when sneezing or coughing. Using the nearest waste receptacle to dispose of the tissue immediately after use. Performing hand hygiene after contact with respiratory secretions or contaminated objects/materials (self or others). Wearing a mask if infected. Health care facilities:Providing tissue and no-touch receptacles for disposing of used tissues.Providing conveniently located alcohol-based hand rub dispensers.Ensuring supplies for hand washing are available at hand-washing sinks. Posting signs and educating patients and staff regarding respiratory etiquette.

In what order does a nurse remove personal protective equipment (PPE)? Gown Eyewear Gloves Shoe Covers Mask

In what order does a nurse remove personal protective equipment (PPE)? Gloves Eyewear Gown Mask Shoe Covers Exactly! The order in which a nurse removes PPE is just as important as donning PPE so that the face, hair, and clothing do not become contaminated.

Portal of Exit

Infectious agents require a means by which to leave the reservoir so they can travel to the next host. These pathways out of the host are called portals of exit. Portals of exit can occur from several sources: Respiratory tract: Sputum, Cough, Sneezing Gastrointestinal tract: Emesis, Stool Genitourinary tract: Genital secretions Open lesions on the skin: Blood, Wound drainage Urinary tract: Urine

Quarantine and isolation are health care practices used to protect the community, and the public as a whole, by limiting exposure to people who have a contagious disease (CDC, 2014).

Isolation separates people who have a contagious disease from people who have not been infected. Quarantine separates and restricts the movement of people who were exposed to a contagious disease, but are not yet ill, to see if they develop the disease. The CDC applies the term quarantine to more than just people. The term also applies to any situation in which a building, conveyance, cargo, or animal is thought to have been exposed to a dangerous infectious disease agent. It is closed off or kept apart from others to prevent disease spread. The Commerce Clause of the US Constitution, under Section 361 of the Public Health Service Act, gives authority to the US Secretary of Health and Human Services to take actions to restrict the entry and spread of communicable diseases from foreign countries into the United States and between states in the United States. The Centers for Disease Control and Prevention (CDC) is tasked with fulfilling these actions when needed by detaining, medically examining, and monitoring persons arriving in the United States, and detaining passengers aboard planes if communicable diseases are suspected. States enforce isolation and quarantine within their borders. It is interesting to note that the last time large-scale isolation and quarantine was used was during the influenza pandemic of 1918-1919 (CDC, 2014). However, in 2014, the CDC announced that a man from Liberia visiting family became ill and was diagnosed with Ebola in Dallas, Texas. The patient was immediately isolated per CDC protocol and died within a few days. As a result of exposure to this patient, hundreds of people were tested for Ebola; only two contracted the infection, and no other deaths occurred. No travel ban was implemented and no new cases of Ebola were or have been diagnosed in the United States since. The federal isolation system in place was effective (CDC, 2014). Isolation and Quarantine, cont'd Communicable diseases for which federal isolation and quarantine are authorized: Cholera Diphtheria Infectious tuberculosis Plague Smallpox Yellow fever Viral hemorrhagic fevers Severe acute respiratory syndromes Influenza that causes a pandemic Protective Isolation: Isolation of an infected person who is contagious is different from "protective isolation." Protective isolation is a procedure used to protect patients who have compromised immune systems. Patients in protective isolation may or may not already be sick. Protective isolation involves placing the patient in a private area such as a hospital room and using meticulous practices to avoid exposing the patient to any infectious microorganisms.

Match each component of the chain of infection to the example that represents it. Source Infectious agent Portal of exit Mode of transmission Muscle Inanimate object Parasite Blood Droplet

Match each component of the chain of infection to the example that represents it. Source = Inanimate object Infectious agent = Parasite Portal of exit = Blood Mode of transmission = Droplet

Match the cleaning method with its use. Germicidal agents Chemical sterilization Physical sterilization Disinfection Cleans medical equipment and skin Product such as chlorhexidine Process that uses gases Process that uses steam or radiation Product non-alcohol based

Match the cleaning method with its use. Germicidal agentsProduct such as chlorhexidine Chemical sterilizationProcess that uses gases Physical sterilizationProcess that uses steam or radiation DisinfectionCleans medical equipment and skin

Match the personal protective equipment (PPE) to the situation in which it is worn. Head cover Goggles Gloves Gown Direct contact with body fluids Protection from airborne microbes Patient on isolation precautions Surgery or labor and delivery Sprays from respiratory droplets

Match the personal protective equipment (PPE) to the situation in which it is worn. Head coverSurgery or labor and delivery GogglesSprays from respiratory droplets GlovesDirect contact with body fluids GownPatient on isolation precautions

Match the type of transmission-based precaution with the infection for which it is implemented. Contact Droplet Airborne Mad Cow Rubeola Herpes simplex (HSV) Rubella

Match the type of transmission-based precaution with the infection for which it is implemented. ContactHerpes simplex (HSV) DropletRubella AirborneRubeola

Actions to Prevent or Slow Infection Transmission

Members of communities can be active participants in slowing the spread of infectious diseases by taking personal and environmental actions. While nurses may not provide direct care within their communities, they can serve as role models or leaders for health-related initiatives. Both health care professionals and non-health care professionals can facilitate actions to prevent or slow the transmission of infectious agents by taking: Personal actions:Performing hand hygiene/washing hands oftenCleaning surfaces and objects routinelyMaintaining immunizationsCovering coughs and sneezesStaying home when sick Community actions:Hand-washing campaignsHand-washing facilities or alcohol-based hand rub dispensers in public areasEncouraging immunizations among citizensClosing schools temporarily when a pandemic occursMaking sick-leave policies more flexibleOffering telework or remote-meeting options when multiple employees are ill with a contagious infectionPostponing or canceling mass gatherings during seasons in which infections are likely, such as influenza season

It is permissible for the nurse to use alcohol-based hand sanitizer on which occasion? Before eating lunch or ingesting food Nothing can be visibly seen on hands After use of the bathroom by nurse After known exposure to norovirus

Nothing can be visibly seen on hands

Susceptible Host

Once an infectious agent gains entry into a host, it does not mean the pathogen will cause infection. Several factors must be present, including: a susceptible host, an adequate dose of infectious agent to ensure it will multiply, and adequate virulence of the infectious agent. When the host's biological defenses are inadequate, or the host has more than one risk factor for infection, the potential for developing infection is increased. A susceptible host is a person who is likely to contract the disease after transmission of an infectious agent. Many factors, including age, nutritional status, chronic diseases, and trauma can contribute to a person being a susceptible host. Any time the chain of infection can be broken, it enhances the potential for preventing the host from developing infections.

actors that Promote Drug Resistance Antibiotics have saved millions of lives. The persistent use of antibiotics over the years, however, has resulted in the development of antibiotic resistance, which is now a global threat (CDC, 2018). Overprescribing of Antibiotics Use of Inappropriate Antibiotics Incomplete Courses of Antibiotics Antibiotic Use in Animals Infection Control Previous

Overprescribing of Antibiotics Antibiotics are often prescribed for minor bacterial infections when they are not needed, or for viral infections when they are not indicated. Use of Inappropriate Antibiotics Antibiotics only treat bacterial infections, but it is often difficult to differentiate between b antibiotic rather than take the time to prescribe the right antibiotic or not prescribe one at all. Incomplete Courses of Antibiotics Inability to monitor patient compliance with antibiotic usage (e.g., failure to take the entire course of medication). Antibiotic Use in Animals Antibiotics are used to treat livestock and fish to prevent infections, which creates a reservoir of potentially resistant bacteria. Infection Control Even when antimicrobials are used correctly, societal conditions accelerate pathogenic drug resistance, for example: Dense populations of people have greater exposure to pathogens. Hospitals and clinics are crowded, also providing exposure to pathogens. Lack of hygiene and sanitation often occurs in urban centers, contributing to the spread of microorganisms.

Drug resistance occurs when microorganisms such as bacteria, viruses, parasites, or fungi grow in the presence of drugs that would normally kill them or limit their growth.

Overview: Microorganisms adapt to their environment to compete for survival. As early as the 1940s, there were documented cases of microorganisms developing resistance to medications that were previously effective at treating the infection. The phenomenon of microorganisms adapting is known as drug resistance or antimicrobial resistance. Examples: A microorganism is considered resistant if replication cannot be stopped by two or more antibiotics sequentially or simultaneously. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that is resistant to many antibiotics and is mostly seen as skin infections within the community. In the health care setting, MRSA can cause bloodstream infections (septicemia), pneumonia, and surgical site infections (CDC, 2015). Concerns Until recently, new drugs were provided in time to treat bacteria that had become resistant to older antibiotics. An unprecedented number of antibiotics were developed over the past 40 years, but the number of new antibiotics being developed has slumped to an all-time low due to development costs. Safe Practice Alert Drug-resistant microorganisms pose a considerable health risk for the general population and health care workers. Appropriate use of personal protective equipment (PPE) and handwashing can significantly decrease the risk of transmission in health care settings.

After educating a patient about respiratory etiquette, which behavior indicates the need for additional teaching? Using sanitizer hand wipes after sneezing Dropping used tissues into waste receptacle Reusing tissues for a productive cough Wearing a mask when leaving the room

Reusing tissues for a productive cough

The federal government can order patients with which diseases to be isolated and/or quarantined? Select all that apply. Smallpox HIV/AIDS Measles Cholera Yellow fever Diphtheria

Smallpox Cholera Yellow fever Diphtheria Explanation: Smallpox Smallpox is an infection for which isolation and quarantine are federally authorized. HIV/AIDS Federal isolation and quarantine are not authorized for HIV/AIDS. Measles Although extremely contagious, federal isolation and quarantine are not authorized for measles. Cholera Cholera is an infection for which isolation and quarantine are federally authorized. Yellow fever Yellow fever is an infection for which isolation and quarantine are federally authorized. Diphtheria Diphtheria is an infection for which isolation and quarantine are federally authorized.

Use of Standard Precautions

Standard precautions (e.g., basic aseptic techniques) are used to break the chain of infection by preventing and controlling the transmission of infectious agents among patients, visitors, and health care personnel. Gloves are used routinely during any patient care activity in which blood or body fluid might be present. If splashing is possible, conservative judgment must be used about whether other PPE (gown, mask, or eyewear) is necessary. Standard precautions are used: For all patients when contact with potentially infectious bodily materials is possible. During contact or potential contact with:Blood and bodily fluids (except perspiration), secretions, and excretions.Nonintact skin.Mucous membranes.Other potentially infectious material.

Sterilization and Disinfection Asepsis of supplies and equipment used for all patients, regardless of setting, is achieved and maintained through sterilization and disinfection. These procedures remove potentially harmful microorganisms and eliminate pathogens that can become potential sources of infection.

Sterilization Sterilization is the process used to destroy all microorganisms on equipment, including their spores. Any equipment that will be used to enter a sterile body cavity, such as surgical instruments, are thoroughly cleaned and sterilized before use. Sterilization methods include: Physical sterilization through use of steam, boiling water, dry heat, or radiation. Chemical sterilization through use of gases, such as ethylene oxide gas or solutions. Prepackaged sterile containers or packages are sterilized through physical or chemical means before purchase. These items must be inspected for damage and sterility expiration dates before use. Disinfection: Disinfection is the use of specialized cleaning techniques and agents to destroy or remove all pathogenic microorganisms except spores. Disinfectants are used to clean medical equipment and skin. These techniques are used for equipment that cannot be sterilized, such as tubing, and skin. Disinfecting agents include: Germicidal agents such as chlorhexidine, formaldehyde, Zephirin (ammonium compound), phenol compounds, bleach Antiseptic agents such as alcohol, hydrogen peroxide, iodine, and benzalkonium chloride

Infectious Process Begins Wiht the Chain of Infection

The infectious process begins with the chain of infection, which has six components: Infectious agent Source of infection Portal of exit Mode of transmission Portal of entry Susceptible host It is important to understand how each of these contributes to the millions of infections that occur in the United States and worldwide every year.

Person Hygiene and Medical Asepsis

The nurse plays a significant role in medical asepsis. The nurse can facilitate the transmission of microorganisms among patients and staff or break the chain of infection by preventing the transmission of infectious agents to multiple patients and staff by taking care of self first, and taking other actions such as: Maintaining personal hygiene. Keeping fingernails short to avoid scratching patients, which opens a portal of entry for infectious agents. Avoiding artificial nails because they harbor microorganisms. Keeping hair short or pulled back. Avoiding wearing rings with grooves or stones, which can harbor microorganisms. Donning protective eyewear and gloves before cleaning equipment contaminated with infectious organic material for self-protection. Avoiding working when ill to prevent spreading infections to susceptible patients or other staff members. According to the Centers for Disease Control and Prevention (2018), microorganisms can live beneath artificial fingernails both before and after using alcohol-based hand sanitizers and hand washing. They recommend that health care providers do not wear artificial nails or extensions when providing direct patient care. In addition, natural nails should be less than ¼ inch long. Additionally, the skin beneath rings harbors a greater number of microorganisms than exposed skin.

Source of Infection (aka Reservoir)

The second link of the chain of infection is the source of infection, also known as the reservoir. This is where the infectious agent lives, receives nourishment, and multiplies. Reservoirs can be human, animal, or inanimate objects such as surfaces, equipment, medications, air, food, or water on which microorganisms can survive. ReservoirDescriptionHumanPeople transmit pathogens when:They have active infectious diseasesThey are infected, but are asymptomatic carriersPatients, health care personnel, family, or friends can serve as reservoirs for infectious agentsAnimalInsectsBirdsAnimals such as mice, rats, pigs, cowsInanimateSoil contaminated with pathogens such as fungi, mold, helminths, and bacteriaWater contaminated with feces and urineFood contamination can result from improper handling and storage of foodContaminated hospital equipment, surfaces, etc.

Match the precaution with its corresponding description. Isolation Separates sick and contagious people from others Quarantine Separates people exposed to a contagious disease Protective isolation Separates people with weak immune systems

· Separates sick and contagious people from others Quarantine · Separates people exposed to a contagious disease Protective isolation · Separates people with weak immune systems