Infection Prevention and Surveillance in Respiratory Care

Flashcards testing knowledge on infection control, HAI surveillance definitions, VAE criteria, equipment reprocessing procedures, and fluid management protocols.

What are the five key recommended components of an infection prevention (IP) program?

The five key recommended components are surveillance, investigation, prevention, control, and reporting.

What are the five key principles that should be part of any infection prevention surveillance program?

1) Use of standard definitions for HAIs; 2) Use of microbiology-based data (including resistance patterns); 3) Establishment of risk stratification for infection risk; 4) Monitoring results prospectively and identifying trends; and 5) Providing feedback to stakeholders within the institution.

What are the three tiers of ventilator-associated events (VAEs) in surveillance order?

Ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and possible ventilator-associated pneumonia (PVAP).

How is a ventilator-associated condition (VAC) defined in VAE surveillance?

An increase in positive end-expiratory pressure (PEEP) and fraction of inspired oxygen ($FiO_2$) for $2$ calendar days or longer after a period of stability.

What clinical findings indicate the presence of an infection-related ventilator-associated complication (IVAC) after a VAC is identified?

An elevated temperature or white blood cell count, along with new antibiotics that have been started and administered for $4$ or more days.

What respiratory pathogen diagnoses meet Criterion 3 for Possible Ventilator-Associated Pneumonia (PVAP)?

Organism identified from pleural fluid, positive lung histopathology, diagnostic test for Legionella species, or diagnostic test on respiratory secretions for influenza virus, respiratory syncytial virus, adenovirus, parainfluenza virus, rhinovirus, human metapneumovirus, or coronavirus.

What are the five critical steps of bronchoscope sterilization or disinfection following point-of-use precleaning and leak testing?

1) Clean (mechanically clean surfaces and internal channels); 2) Disinfect (immerse in high-level disinfectant/sterilant for product-specific time); 3) Rinse (with sterile, filtered, or tap water); 4) Dry (rinse channels with alcohol and dry with forced air); and 5) Store (hang vertically in an enclosed cabinet).

What immediate step must be taken if a bronchoscope fails a leak test during reprocessing?

The bronchoscope should be immediately removed from the water, and the endoscope manufacturer should be contacted for further instructions.

Which pathogens are most frequently reported in hospital-acquired infections associated with contaminated bronchoscopes?

Mycobacterium tuberculosis, nontuberculosis mycobacteria, and Pseudomonas aeruginosa.

Who should reprocess single-use medical devices according to recommendations by the U.S. Centers for Medicare and Medicaid Services?

Single-use devices should be reprocessed by an FDA-approved third-party reprocessor, not by hospitals.

Within what timeframe must remaining fluid from a opened large stock bottle of sterile fluid be discarded?

Within $24$\,hours.

What action should be taken if the outside of a laboratory specimen container becomes contaminated during gathering?

The caregiver must either disinfect the external surface of the container or place it in an impervious bag.

At what oxygen flow rate are humidifiers considered unnecessary?

Oxygen flows $< 4$\,L/min.

What is the recommended practice for cleaning small-volume nebulizers between treatments on the same patient?

Clean, disinfect, rinse with sterile water, and air dry between treatments.

According to the Cystic Fibrosis Foundation guidelines, how frequently should disposable nebulizers be discarded for hospitalized patients with cystic fibrosis?

Every $24$\,hours.

What is the bacterial efficiency rate of high-efficiency particulate air/aerosol (HEPA) filters used on ventilators?

$$99.97\%$$

Where should an inspiratory HEPA filter be positioned in a ventilator circuit?

Between the machinery and the external circuit, proximal to any humidifier.

What are the guidelines regarding the routine changing of ventilator circuits?

Ventilator circuits should not be changed routinely for infection control purposes; they should only be changed when visibly soiled or malfunctioning.

For how long can a heat-and-moisture exchanger (HME) be safely used before replacement?

HMEs can be used safely for $48$\,hours, and for up to $7$\,days in specific patient populations.

How should non-disposable bag-mask devices be reprocessed between patients?

They should be completely disassembled and sterilized or high-level disinfected.

What is the policy regarding daily changes for closed-system (sheathed) suction catheters?

There is no need to change a closed-system suction catheter daily.

What factors must be evaluated when selecting a reprocessing method for reusable respiratory equipment?

Regulatory requirements, information in the equipment manufacturer's instructions for use, infection risk (critical, semicritical, noncritical), available hospital reprocessing resources, and hospital policy.