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Infection Control Exam Questions And
Accurate Answers
Healthcare Personnel - answer All paid and unpaid persons who work in a healthcare facility who,
- Have professional or technical training and provide patient care, and
- Provide services that support the delivery of healthcare. Nosocomial Infection - answer An infection acquired during hospitalization; they are potentially caused by organisms that are resistant to antibiotics. Ex: MRSA Standard Precautions - answer Precautions that apply to the care of all patients in all healthcare settings, regardless of the suspected or confirmed presence of an infectious agent, & constitutes the primary strategy for the prevention of HAIs (Healthcare Associated Infections). Chain of Infection - answer 3 Elements
- Source of reservoir of infectious agents.
- Susceptible host with a portal of entry receptive of the agent.
- Mode of transmission for the agent. HBV - answer What is consider the major occupation hazard to HCP? HBV, HCV, HIV - answer The transmission of which of the following pathogens is prevented or reduced by standard precautions? Measles Virus, Mumps Virus, Rubella Virus - answer Pathogens transmitted primarily by droplet inhalation? HSV type 1 (Herpes), HSV type 2, VZV (Chickenpox) - answer Pathogens transmitted primarily by direct contact with vesicular fluids/exudates? Source Control Measures - answer -Hand Hygiene -PPE
-Cough Etiquette -Have policies in place -Clean Environment -Safe disposal of waste -Medical History Prior to Treatment Respiratory Protection Controls - answer Employees must wear respirator to cover nose, mouth, entire face or head to protect themselves from harmful agents. OHCP providing care to a patient with suspected or confirmed airborne infectious disease must use a respirator with a filtration capacity of >/= 95%. HCP must wear a surgical mask for all close contact with the patient. The mask should be donned upon entering and removed before exiting the DTR. Diseases that are preventable by vaccines in the US - answer Measles, Pertussis (whooping cough), Influenza, Polio, Tetanus, Hepatitis B, Mumps, HPV, Tuberculosis, Varicella Hepatitis B Vaccine - answer Injection given in 3 dose series on a 0,1, and 6-Month Schedule Influenza Vaccine - answer Given yearly and changes every year because the virus changes. Usually given in the arm or as a nasal mist. MMR Vaccine - answer Measles, mumps, and rubella vaccine. Given to children around 9- 15 months of age, with a second dose at 15 months to 6 years of age, with at least 4 weeks between doses. This trivalent vaccine is the vaccine of choice for routine adult vaccination. This vaccine contains live attenuated virus grown in chick embryo and live attenuated virus grown in human diploid cell culture. There is no evidence to support a causal association between this vaccine and autism. HPV - answer human papilloma virus, sexually transmitted. There is a vaccine that prevents the HPV strains most likely to cause genital warts and cervical cancer. The vaccine given is named Gardasil and consists of 3 separate shots, the second shot is given 2 months after the first; the third shot is given 4 months after the second shot. 3 IM doses at 0, 2, 6 months. A bivalent vaccine (Cervarix) is approved for use in girls and young women 9-15 years of age to prevent diseases. Hepatitis A Virus (HAV) - answer The most preventable type of hepatitis. It is spread through the fecal-oral route, and contaminated food. Recommended for adults with
pathogenic and other organisms can never be reduced to zero. Disinfection - answer Defines a process that is less lethal than sterilization, i.e., disinfection destroys some, but not all recognized pathogens and it does not predictably eliminate bacterial spores Disinfectants - answer Germicides that are applied to inanimate objects such as instruments and other devices and environmental surfaces Germicide - answer refers to both disinfectants and antiseptics Antiseptics - answer Germicides applied to skin and other living tissue Detergents - answer are compounds with both hydophilic and lipophilic parts - the term "soap" is often used to refer to such products. High-level disinfectants - answer They kill all pathogens but not all bacterial spores Intermediate-level disinfectants - answer Kill mycobacteria, vegetative bacteria, most viruses and fungi, but they will not kill spores Low-level disinfectants - answer Kill most vegetative bacteria and some viruses and fungi. Cleaning - answer The physical action of scrubbing patient-care items with water and a detergent or an enzymatic product and rinsing them with water to remove contaminants.
Spaulding's classification of patient-care items - answer Patient-care items can be categorized as critical, semi-critical and non-critical predicated on the degree of risk for healthcare-associated transmission of infectious diseases with their use. Steam Sterilizers (Autoclaving) - answer *Requires exposure of each item to direct steam contact at a specified temperature and pressure for a defined period of time. *The most dependable and economical process. It is the most widely used method for wrapped and unwrapped critical and semi-critical items that are not heat and/or moisture sensitive. 2 basic types:
- Gravity Displacement.
- High-Speed Prevacuum. Processing contaminated reusable patient-care items - answer There should be a central processing area (CPA) of adequate size with four successive stations for: (1) receiving and cleaning (2) preparation and packaging (3) sterilization or disinfection (4) storage of sterilized units (e.g., individual packs, peel pouches, containers, etc...) Each station should be physically separated to control traffic flow and to contain contaminants during the process. If physical separation is not practical, spatial separation might be satisfactory. Preparing and packaging instruments - answer At the second station of the CPA, the
-The units should then be stored in a clean, dry, closed cabinet. -Storage practices for wrapped sterilized instruments should be event-related. -Event-related practices recognize that packages remain sterile indefinitely, unless an event causes a package to become contaminated (e.g., torn, wet, or open packaging). -Prior to distribution to the point of use, the sterile instrument units should be inspected to verify barrier integrity and dryness. -When the packaging is compromised (i.e., torn, wet, or open), the instruments should be re-cleaned, re-packaged in a new wrap, and re-sterilized. -The date of sterilization and the sterilizer used, noted on the outside of the packaging material, should facilitate the retrieval of suspected instrument units in the event of a sterilization failure. Sterilization Monitoring Record (SMR) - answer Documentation in the form of a log, is an absolute requirement of quality assurance. -What is the 4th component of quality assurance, that provides evidence the monitoring process is ongoing and that the cycle parameters are being confirmed in a timely manner by all appropriate indicators. -It provides a mechanism for determining if a recall is indicated and, in combination with the date and sterilizer number on each pack, the extent of the recall. -Finally, it establishes accountability. What are the procedures to follow in the event of a positive spore test? - answer -The sterilizer should be removed from service! -All records of physical and chemical monitoring since the last negative BI test should be reviewed. -If the physical (ex: time, temperature, and pressure) & chemical (ex: internal or external) indicators demonstrate the sterilizer is functioning
CORRECTLY, a single positive spore test probably does not indicate sterilizer malfunction, consider the possibility of an operator error* -Review cleaning, packaging, loading, and spore testing procedures with all persons who work with the sterilizer. In the absence of mechanical failure of the sterilizer unit, overloading, failure to provide adequate package separation and incorrect or excessive packaging material are all common reasons for a positive BI. Using the same cycle that produced the failure, repeat the spore test immediately after correctly loading the sterilizer. -If physical and chemical monitoring indicates adequate processing and the repeat spore test is negative the sterilizer can be put back into service. If packaging, loading, and operating procedures have been confirmed as performed correctly but the repeat BI test is positive, the sterilizer must remain out of service until it has been inspected, repaired, and re-challenged with BI tests in 3 consecutive empty-chamber sterilization cycles. -Following a positive BI, a prudent policy is to assume that a positive spore test is an indication of sterilizer malfunction. All materials processed in that sterilizer, dating from the sterilization cycle having the last negative BI to the next cycle indicating negative biological indicator results, should be considered non-sterile. All items from suspect loads dating back to the last negative BI should be re-cleaned, re-wrapped, and re-sterilized. Contaminated Laundry - answer OSHA defines this as, laundry which has been soiled with blood or other potentially infectious materials (OPIM) or may contain sharps. HAIs linked to this are so few that the overall risk of disease transmission during the laundry process is negligible. Employers must launder workers personal protective garments or uniforms and other laundry contaminated with blood and OPIM. Regulated Medical Waste (RMW) - answer -Any waste containing infectious material that may pose a threat to health and safety. -Waste generated in healthcare facilities may be categorized as office waste, hazardous
common with contaminated objects) -Exposed HCP should be monitored for skin lesions (initially could look like spider bites) -1st step in treating purulent skin infection is incision, drainage and antibacterial coverage. Allergic Contact Dermatitis (ACD) - answer - T cell-mediated delayed hypersensitivity reaction (caused by fragrances, less commonly by emulsifiers in hand-hygiene products)
- Rash, redness, itching; begins 24-48 hours after contact, and can progress to oozing skin blisters and spread on body. Irritant Contact Dermatitis (ICD) - answer -The most common adverse reaction to LATEX products, specifically to latex gloves. It is characterized by dry, cracked, itchy, irritated areas of the skin (usually of the hands). The time of onset is gradual (over several days) as a result abrasion and maceration from donning and removing gloves, repeated hand washing and drying, incomplete hand drying, the use of cleaners and sanitizers, and exposure to other workplace products and chemicals Topical high-potency corticosteroid: Fluocinonide (Lidex®), 0.05% ointment - answer Medication available to treat Allergic Contact Dermatitis (ACD) Principal prerequisites for cross-infection include a ____________. - answer 1) Source or reservoir of infectious agents
- Susceptible host with a portal of entry receptive of the agent
- Mode of transmission for the agent Modes of Transmission: Pathogens may be transferred from the source to a host by_____. - answer 1) Indirect
Contact Transmission
- Direct Contact Transmission
- Respiratory Transmission
- Airborne Transmission Goggles and Face Shields - answer Goggles must be worn by OHCP and patients to prevent the transmission of pathogens through the conjunctival mucosa either directly (e.g., splash, spatter, spray, or aerosols) or by touching the eyes with contaminated hands or other objects.1-3,13 Goggles, which are Class I medical devices, must fit snugly from the corners of the eyes across the brow. Indirectly-vented goggles with anti-fog coating provide the most reliable eye protection. Personal eyeglasses and contact lenses are NOT considered adequate eye protection. Several different types, styles, and sizes of goggles should be made available to meet individual needs. Goggles that fit comfortably over prescription glasses are available and contact lenses may be worn with recommended eye protection devices. Contact lens users should vigorously adhere to hand hygiene guidelines when inserting, adjusting or removing contact lenses. While goggles provide effective eye protection, they do not protect other parts of the face. Face shields with high crowns and chin protection that wrap around the face to the point of the ears are recommended for infection control purposes.13 They should fit snugly and the foam brow-band contoured to the wearer. Since face shields are open from below, they are to be worn with surgical masks. Disposable face shields attached to masks do not provide optimal protection. The front and sides of goggles and face shields are likely to be contaminated. However, the ties, ear-loops, and/or head-bands used to secure these devices to the head are considered "clean" and, therefore, safe to touch with bare hands. Following use, eye protection devices should be placed in a designated receptacle. Wearing gloves, these devices should then be cleaned with soap and water, disinfected with a hospital level
-If additional material is needed during treatment use aseptic technique to retrieve needed items (e.g., sterile cotton forceps or pliers, an over-glove barrier, or remove gloves and perform hand hygiene). -Complete charting and computer entries after removing gloves and performing hand hygiene. -Remove PPE and perform hand hygiene before leaving the treatment area. -Wear appropriate attire outside the D DTR (Dental Treatment Room) Turn-Around Procedures Between Patients - answer -Wear heavy-duty utility gloves and other PPE while handling contaminated instruments and cleaning contaminated surfaces. -Place all disposable sharps in designated sharps container in the DTR. -Dispose of all non-sharp, regulated medical waste following local policy. -Place instruments in cassette tray (or properly labeled and approved container) for transport to the central sterilization room (CSR). -Flush water and air lines for 20-30 seconds after each patient from any device connected to the dental water system that enters the patient's mouth (e.g., hand pieces, ultrasonic scalers, air and water syringes). -Remove dental hand piece(s), including slow speed hand piece motors, and other intraoral instruments that can be removed from air and waterline couplings of dental units. -Follow manufacturer's instructions for cleaning, lubrication, and sterilization of hand pieces and other intraoral instruments and devices removed from dental units. -Remove and dispose of all disposable barriers. -Clean and disinfect clinical contact surfaces that were not barrier protected with an EPA- registered hospital disinfectant with a tuberculocidal claim (i.e., intermediate-level disinfectant). -Remove gloves and perform hand hygiene. -Don a fresh pair of gloves and transport instrument trays, packs, and cassettes to the
receiving side of CSR or another designated holding space. -Return to the DTR without touching any surfaces while enroute to remove PPE and perform hand hygiene. -Prepare the DTR for the next patient. DTR (Dental Treatment Room) at the End of the Day - answer -Wear appropriate gloves, face protection, and eye protection while cleaning contaminated surfaces. -Clean and disinfect all contact surfaces, dental unit surfaces, and countertops with an EPA-registered disinfectant. -To facilitate cleaning, treatment rooms should be free of all unnecessary equipment and supplies. -Empty and clean amalgam trap container per dental unit manufacturer's recommendations. -Flush and clean the HVE system per manufacturer's recommendations. -Flush and clean each water line and suction hoses, follow manufacturer's instructions if waterline treatment products are used. -Follow manufacturer's instructions for cleaning and maintenance of dental unit water bottles. -Dispose of regulated waste per local policy. -Clean and disinfect sink area. -Ensure only DTR cleaning materials and no patient care items are stored under the sink. -Inventory consumable unit dose packs, replenish as necessary per local policy. Note: Routinely check for expiration dates on solutions, materials and dispensable items per command policy. -Remove PPE (clean and disinfect reusable PPE) and perform hand hygiene. T/F: Generally blood and/or saliva-tinted items (e.g., disposable clinic gowns, gloves, and patient bibs) are NOT considered regulated waste and are placed in the regular trash receptacle? - answer True
use. Examples include: Surgical instruments, periodontal scalers, scalpel blades, burs, and explorers. Heat-Tolerant Semi-Critical and Critical Items - answer Heat sterilized in an FDA cleared device. Heat-Sensitive Items - answer Items that cannot be sterilized with heat; Instead the are sterilized with ethylene oxide or an FDA-registered sterilant (e.g., products containing glutaraldehyde, glutaraldehyde with phenol, hydrogen peroxide, or hydrogen peroxide with peracetic acid). Preparation and Packaging after Sterilization - answer -The cleaned and inspected instruments are assembled into cassettes, tray sets, or packs with hinged instruments open and unlocked. -An internal chemical indicator is placed in each cassette, tray set, or pack. -If the internal indicator is not visible from the outside of the wrapped and sealed package, an external chemical indicator is placed on each cassette, trays set, or pack to monitor sterilization process. Sterilization Instructions - answer -The sterilizer is loaded according to manufacturer's recommendation, in single layers or in racks to increase circulation around the instruments. -The cycle time, temperature, and pressure are set according to the manufacturer's recommendation. -Upon completion of the sterilization cycle, the packages are allowed to dry and cool before removing them from the sterilizer. Storage Instructions - answer -Sterilized items are stored in a clean, enclosed, and dry environment.
-Sterilized packages remain sterile indefinitely, unless an event causes it to become contaminated (e.g., torn or wet packages). Monitoring of the Sterilization Process - answer -Mechanical - Confirm cycle time, temperature, and pressure by observing the gauges or displays on the sterilizer for each load. -Chemical - Note color changes of time and temperature sensitive internal and external chemical indicators, which reflect physical conditions during the sterilization process. -Biological - Monitor weekly the sterilization process by an appropriate spore test (according to manufacturer's time, pressure, and temperature recommendation). Handpieces - answer -Heat sterilized according to manufacturers recommendations. For most handpieces, the following generic protocol is appropriate: -Before removing handpiece from hose the lines are flushed for 20-30 seconds. -Handpiece (with the bur removed) is scrubbed thoroughly under running water, rinsed thoroughly, and dried. -Handpiece requiring pre-sterilization lubrication is lubricated. -After lubrication, the handpiece is reattached to hose (with bur or blank reinserted) and the rheostat is activated to remove excess lubricant. - CRITICAL -Fiberoptics are cleaned with a cotton swab, dampened with isopropyl alcohol to remove excess lubricant. -Handpieces are packaged and sterilized in a steam autoclave Saliva Ejectors - answer -Prevent backflow in low-volume suction lines.
Occupational Exposure - answer Means reasonably anticipated skin, eye, mucous membrane, or parenteral contract with blood or OPIM that may occur during the performance of an employee's duties in an oral healthcare setting. Waste Segregation - answer The various waste categories generated in oral healthcare facilities (office waste, hazardous waste, universal waste, and medical waste) must be separated at their points of origin Solid RMW Care/Instructions - answer -OSHA requires that this be placed in containers that are closable, constructed to contain all contents, and prevent leakage of fluids during handling, storage, transport, or shipping. -They must be labeled with the universal biohazard symbol and the word "BIOHAZARD," and/or color-coded red. -The containers must be lined with biohazard bags made of LLD or Hi-D polyethylene resins of sufficient strength to prevent rupture or leaks. Storing RMW (Regulated Medical Waste) - answer -The storage of RMW must be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories. In preparation for storage, sharps containers must be closed. If there is a chance of leakage, the container must be placed in a secondary container.4 Red biohazard bags must be "twist tied." If a bag seems especially heavy, it must be place inside another red biohazard bag prior to moving it to storage. -RMW must be stored in a designated, conveniently located storage area. The storage space must have limited access; must be well ventilated, and must be inaccessible to pests. The universal biohazard symbol must be clearly visible on the access door to the storage area and state "authorized personnel only" (Figure 12).4 Any refrigerator or freezer used for storage of RMW must also be clearly be marked with the universal biohazard symbol.
Disposal of Lead Foil in Radiographic Film Packets (Lead Containing Waste) - answer Elemental lead from lead foil in radiographic packets is a leachable toxin that can contaminate the soil and groundwater in landfill sites. Lead foil must be treated as hazardous waste. Collect and store lead foils in a wide-mouthed, airtight container labeled "Hazardous Waste - Lead Foil." Once the container is full, have an approved hazardous waste transporter deliver it to an approved hazardous waste management facility for recycling or disposal. Lead Containing Waste: Leaded Aprons and Collars - answer Elemental lead from leaded aprons and other protective devices (e.g., leaded thyroid shields) is a leachable toxin that can contaminate soil and groundwater in landfill sites if these items are disposed of as non-hazardous office waste. Unwanted leaded aprons and collars must be treated as hazardous waste. Have an approved hazardous waste transporter deliver unwanted leaded safety devices to an approved hazardous waste management facility for recycling or disposal Disposal of Chemical Disinfectants and Sterilants - answer 1) Ensure office personnel have read the SDS for all chemicals used in the oral healthcare facility and are trained to handle hazardous chemicals.
- Avoid the use of chemical disinfectants and sterilants, especially halogenated products (i.e., those containing chlorine or iodine), and glutaraldehydes) when other alternatives are available. a. Follow manufacturers' recommendations on treatment and disposal of waste disinfectants and sterilants. *DO NOT POUR CHEMICAL DISINFECTANT AND STERILANTS INTO A SEPTIC SYSTEM. b. Paper or cloth products impregnated with disinfectants and sterilants may be disposed of as non-hazardous office waste. c. Rinse empty disinfectant and sterilant containers with water, remove or deface labels to indicate the container no longer contains hazardous chemicals, and discard as non- hazardous office waste.
