Chapter 96: Antiseptics and Disinfectants

Alcohol hand sanitizers are not effective against which organisms because they produce spores? (select all that apply) A. Bacillus anthracis B. Clostridium difficile C. methicillin-resistant Staphylococcus aureus (MRSA) D. Mycobacterium tuberculosis E. VRE

A and B

Why is hexachlorophene no longer used as a preoperative scrub? (select all that apply) A. in can be absorbed through intact skin B. it can depress the CNS causing stupor and death C. it can encourage the overgrowth of gram negative bacteria D. it does not stop the bacteria from replicating E. it frequently damages the liver

A and C

Which antiseptics should a nurse choose to prepare intact skin before an invasive procedure? (Select all that apply.) A. Chlorhexidine gluconate [Hibiclens] B. Ethanol (ethyl alcohol) C. Hydrogen peroxide D. Povidone-iodine [Betadine] E. Hexachlorophene

A, B, and D Rationale: Chlorhexidine gluconate, ethanol, and povidone-iodine can be used as topical antiseptic agents. Hydrogen peroxide and hexachlorophene can be caustic, causing burns of the skin or mucous membranes.

The OR nurse is preparing to apply benzalkonium chloride as a surgical scrub. Before applying the solution, it is a priority for the nurse to do what? A. rinse the skin with water and alcohol B. shave the area C. wash the skin with soap D. warm the solution

A. Rationale: the skin must be rinsed with water and alcohol because this chloride scrub is inactivated by soap and must be removed before applying this solution

The priority reason for not wiping the subcutaneous heparin injection site with an isopropyl alcohol pad immediately after injecting the medication is to avoid what? A. brusing B. neutralizing the heparin C. poor absorption of the heparin D. significant pain

A. Rationale: isopropyl alcohol promotes local vasodilation and can thereby increase bleeding fro needle punctures and incisions which can cause bruising

Which is the least significant in preventing surgical incision site infection? A. preoperative scrubbing of surgical site for antiseptic B. preoperative scrubbing of scrub nurse's hands C. rigorous disinfection of operating room and fixtures before surgery D. sterilization of surgical equipment

A. Rationale: it has been discovered through research that scrubbing the site before surgery is actually not as effective as personal hygiene because most of the infections are not caused by microbes on the pt's body they come from the healthcare professionals hands and tools

Which is an example of sterilization? A. autoclaving surgical instruments B. gowning before entering a room where a pt is in protective isolation C. personal respiratory equipment for TB D. standard precautions

A. Rationale: sterilization is the complete destruction of microbes which occurs when instruments are sterilized in an autoclave

Which statements about antiseptics, disinfectants, and sanitization does the nurse identify as true? (Select all that apply.) A. Sanitization indicates complete destruction of all microorganisms. B. Antiseptics are used to bathe neonates. C. Disinfectants are commonly used to decontaminate surgical instruments. D. Antiseptics are commonly used to treat local infections. E. Germistatic drugs are used to kill all microorganisms.

B and C Rationale: Sterilization indicates complete destruction of all microorganisms; sanitization implies that contamination has been reduced to a level compatible with public health standards. Antiseptics are seldom used to treat local infections; systemic antimicrobial drugs are often used to treat infections. Germistatic drugs suppress the growth and replication of microorganisms; germicides are used to kill all microorganisms. The other two statements are true.

To ensure effectiveness of ethyl alcohol as an antiseptic, the nurse should do what? A. apply the alcohol directly to open wounds after medicating the pt for pain B. use alcohol combination with other antimicrobial agents C. use an alcohol with a concentration greater than 75% D. use a gel that prolongs evaporation of the alcohol

B.

What is the surgical scrub that is fast acting and antibacterial and remains active on the skin after rinsing? A. benzalkonium chloride B. chlorhexidine C. hexachlorphene D. povidone-iodine

B.

The nurse delegates the cleaning of an automatic blood pressure machine to an unlicensed assistive personnel (UAP). The nurse should instruct the UAP to use which agent to clean the equipment? A. hexachlorophene B. a disinfectant such as glutaraldehyde (Cidex plus 28) C. an antiseptic such as alcohol D. povidone iodine

B. Rationale: disinfectants are used to clean equipment. B is used to disinfect and sterilize surgical instruments and other medical supplies including respiratory and anesthetic equipment, catheters and thermometers. It is too harsh for antiseptic use.

A nurse plans tracheostomy care by selecting hydrogen peroxide as one of the supplies to use for which purpose? A. Antisepsis of a tracheostomy stoma B. Disinfection of the inner cannula C. Use of foaming action to facilitate healing D. Exerting germicidal action on secretions

B. Rationale: Hydrogen peroxide is an excellent disinfectant and sterilizing agent, but it is useless as an antiseptic. Hydroxyl free radicals, which are responsible for antimicrobial effects, are destroyed when peroxide is acted on by catalase, an enzyme found in all tissue. Contact with tissue terminates the germicidal action. Liberation of oxygen causes frothing that loosens debris to facilitate cleansing.

The nurse should scrub the hands and forearms with an antimicrobial soap for surgical scrub asepsis for how long? A. 1-2 minutes B. 2-6 minutes C. 6-8 minutes D. 8-10 minutes

B. 2-6 minutes

When the nurse is preparing to cleanse a wound which preparation would be most appropriate and effective? A. glutaraldehyde B. iodine solution C. iodine tincture D. povidone-iodine

B. iodine solution Rationale: iodine solution is used to treat wounds and abrasions because alcohol is an irritant this is used on broken skin (iodine tincture is used on intact skin)

The nursing professor is orienting nursing students to the intensive care unit. Hygiene instructions should include which directive? A. alcohol handrubs should be used when hands are visible dirty B. all forms of jewelry are not allowed C. do not wear artificial nails D. trim natural nails to no more than 1/2 in beyond the fingertip

C

The CDC recommends that before entering a pt's room, the nurse should do what? A. wash hands with antibacterial soap and water B. wash hands with a non antibacterial soap and water C. use an alcohol-based handrub D. wash hands with chlorhexidine and water

C. Rationale: the CDC recommends the use of an alcohol based hand up rather than soap and water for routine hand antisepsis

Which technique should a nurse implement when performing hand hygiene before starting an intravenous (IV) catheter on a patient? A. Wash the hands with soap and water and dry the hands on a multiple-use hanging cloth towel. B. Scrub the hands and forearms with antimicrobial soap for 2 to 6 minutes. C. Decontaminate the hands with an alcohol-based handrub and allow to dry. D. Clean underneath the fingernails with a nail cleaner under running water.

C. Rationale: Based on the hand-hygiene guidelines for routine hand antisepsis established by the Centers for Disease Control and Prevention (CDC), alcohol-based handrubs are preferred to soap and water if the hands are not visibly soiled. A multiple-use hanging cloth towel is not recommended for use in healthcare settings. Surgical hand antisepsis, including cleaning underneath the fingernails with a nail cleaner under running water, is not recommended by the CDC for an IV start.

Which hand-hygiene measure by healthcare workers has been found most effective in reducing the spread of infection in healthcare settings? A. Using soap and hot water to wash the hands vigorously for 5 seconds B. Removing blood and body fluids from the hands with ethanol C. Using an alcohol-based handrub for routine hand hygiene D. Changing gloves if moving from a clean body site to a contaminated site

C. Rationale: Thorough hand washing has been found to be the most effective means of controlling the spread of infection. The CDC's guidelines recommend use of an alcohol-based handrub for routine hand hygiene to improve adherence among healthcare workers. Hot water increases the risk of dermatitis. A non-antimicrobial soap and water should be used to wash visibly dirty hands. Gloves should be changed when moving from a contaminated body site to a clean site.

A healthcare worker has been exposed to B. anthracis on the hand. What is the most appropriate action by the healthcare worker? A. apply an alcohol-based hand rub to the hands B. start a systemic-based anti-infective drug C. soak the hand in povidine-iodine D. wash both hands with soap and water

D. Rationale: soap and water is preferred over alcohol based handrubs after exposure to spore forming bacteria like this one. Systemic anti infective drugs are preferred for treating an established local infection. Povidine iodine is used primarily for prophylaxis of postoperative infection. In addition, povidine iodine is used to sterilize equipment, although superior disinfectants are available.

Which statement about the use of glutaraldehyde [Cidex] does the nurse identify as true? A. It is the most effective agent for antisepsis. B. It is not effective for killing viruses. C. Surgical instruments should be soaked in glutaraldehyde for a maximum of 1 hour. D. Glutaraldehyde should be used in a well-ventilated area.

D. Rationale: Because of toxic fumes, glutaraldehyde should be used in a well-ventilated area. Glutaraldehyde is too harsh for use with living tissue and therefore is not effective for antisepsis. It is effective for killing viruses. Surgical instruments should be cleansed of all blood and tissue components and immersed in glutaraldehyde for at least 10 hours.

Before applying povidone-iodine [Betadine] to a patient's skin, it is most important for the nurse to ask the patient about allergies to what? A. Penicillin B. Bees C. Latex D. Seafood

D. seafood Rationale: Seafood can be rich in iodine; therefore, a patient who is allergic to seafood has a high risk of being allergic to povidone-iodine. Penicillin, bees, and latex are not associated with allergies to povidone-iodine.

Sterilization kills everything including...

SPORES (think of C diff)

What is the most common antiseptic?

alcohol (ethanol)

Antiseptic

applied to living tissue

Disinfectant

applied to objects, too harsh for living tissue, and applied most frequently to instruments and facilities

Ethanol is an effective virucide and kills most common pathogenic bacteria but it is inactivate against....

bacterial spores including C. diff

Povidine-iodine is

betadine

Iodine and chlorohexidine are used to

clean wounds and decrease microbial contamination before surgery

Iodine tinture is used to

cleanse INTACT skin to cleanse skin to prepare for an IV infection and withdrawal of blood

Sterilization

complete destruction of all microorganisms

Germistatic drug

decreases growth and replication but does not kill germs (prevents replication)

Why is bacitracin no longer widely used?

doesn't work well in wounds because there is poor penetration into the wound

Toxicity to organisms is determined by...

duration of exposure to antiseptic/disinfectant

Chlorohexidine uses

fast acting antiseptic that acts on gram positive and negative bacteria and is used for central lines and dressing changes (can also be a mouth rinse)

Hydrogen peroxide

foaming loosens debris and facilitates cleaning of the wound

Which bacteria is chlorohexidine active against?

gram positive and gram negative bacteria

Example of a phenol disinfectant and its use

hexachlorophene which is bacteriostatic and is used as a hand disinfectant in some clinical settings

Why are hand sanitizers not as effective for preventing certain illnesses?

it doesnt always work on spores like C. diff

Germicide

kills microorganisms; bactericides, virucides, fungicides, and amebicides

Iodine is most widely used because it is...

less costly than other agents and has a very low toxicity

Do antiseptics contribute well to prophylaxis agents infection when applied directly to the pt before surgery?

not very much, research shows that most post op infections are caused by organisms that were not present at the incision site (healthcare staffs use antiseptics and those who come in contact with the pt are more helpful)

Topical antiseptics are used more now for....

prevention of infection (prophylactic)

Antiseptics are...

prophylactic to prevent disease

Phenols

rarely used as an antiseptic and is now used as a disinfectant

Sanitization

reduction of contamination to a level compatible with public health standards

An antiseptic can cause local tissue damage due to a....

sensitivity to something in the antiseptic

Hexachlorophene

used as a hand disinfectant in some clinical settings

Benzalkonium chloride

used as a surgical scrub inactivated by soap so skin needs to be rinsed well with water before this is used

Chlorine

used for water supplies and is not used clinically

Iodine compounds

used to be employed as an antiseptic, and is now used most widely used as germicide by being able to kill all known bacteria, fungi, Protozoa, viruses, and yeasts

Thimerosal

used to be used in vaccines but isn't anymore (is still in the inactivated flu vaccine)

What is the best way to get rid of spores on hands?

washing with soap and water because will wash the spores off of the hands

Iodine solution is used to treat

wounds and abrasions because alcohol is an irritant this is used on broken skin