LO4 mass flashcards

isolation precautions

• standard precautions to reduce transmission

• used when highly transmissible or epidemiologically important

airborne precautions

• implemented when droplet nuclei is smaller than 5 microns

• measles, chickenpox, TB

• have patient in a private room with negative pressure airflow of at least 6 exchanges per hour

• mask or respiratory protection needed

droplet precautions

• when droplets larger that 5 microns are present

• rubella, mumps, diphtheria, etc.

• have patient in private room

• use mask

contact precautions

• risk of direct patient or environmental contact

• colonization or infection with multi drug resistant organisms is a risk

• have patient in private room and use gloves and gown

high risk injuries

• needlesticks

• other sharp injuries

• cuts and scratches

• bites, especially with blood in mouth

• spraying/ splattering on broken skin or mucous membranes

high risk fluids

• blood

• semen

• vaginal secretions and amniotic fluid

• other body fluids

• saliva (hep B)

what to do when exposed to blood or body fluids

1. administer support/first aid care (wash well with soap and water and encourage bleeding), flush membranes with cool water

2. administer treatment (vaccinations and medications) report to emergency department, source should be tested

3. follow-up (call with communicable health nurse, blood tests, report to school nurse, vaccinations)

low risk PPE situations

gloves, goggles, surgical mask, maybe gown

• nausea/vomiting

• fever/chills

• minor to moderate bleeding

• chest pain

• strokes

• trauma

high risk PPE situations

goggles, gloves, N96, hoods, gowns, shoe covers

• ebola virus

biomedical waste

portion of medical wastes that require special precautions due to waste being:

• infectious

• sharps

• cytotoxic

• especially sensitive due to nature of waste (body parts)

cytotoxic chemical wastes

inhibit or prevent the functions of cells

• IV needles

• tubing

• syringes used to injects cytotoxic drugs

• PPE used while handling cytotoxic drugs

marked rigid, sealed containers, red and bear cytotoxic symbol

• incineration

human anatomical waste disposal

human tissues, organs, and body parts

sealed rigid containers, colour coded red

incineration

human blood and body fluids waste

blood, blood products, body fluids

saturated or dripping with blood

vials - sharps

solids- yellow biohazard bag

fluids - rigid, leak proof, yellow container

saturated items - collect with solids

general waste

contact with blood, exudates, or secretions but are not saturated or dripping

do not need special procedures

items should be dry

should only contain trace amounts of blood in diluted form

are closed circuit and cannot be opened easily

do not contain infection fluid

microbiology laboratory wastes

all microbiology laboratory cultures, stocks or specimens of microorganisms, live or attenuated vaccines, human or animal cell cultures and laboratory material that has come into contact with such

dispose in yellow containers with biohazard symbol, rigid with fixed lid

sharps wastes

penetrate the skin or have or are likely to come into contact with infectious agents

yellow, biohazard symbol, fill line

microorganisms in order of resistance to disinfection

< vegetative bacteria, lipid viruses, fungi, non-lipid viruses, tubercle bacilli, bacterial spores

advantages and disadvantages of alcohol cleaning

advantages

• economical

• very little irritation

• ability to kill bacteria, lipid viruses, and tubercle bacilli

disadvantages

• antimicrobial action diminishes with heavy microbial load and organic material

• does not kill spores or non-lipid viruses

• rapid evaporation

advantages and disadvantages of chlorine based disinfectant

advantages

• economical and readily available

• rapid antibacterial action

• kills tubercle bacilli and viruses

• effective in diluted solutions

disadvantages

• corrosive to metals and degrades plastics

• must be diluted fresh daily

• unpleasant odour and irritative

• inactivated by organic matter

• only sporadical at high concentrations

• ruins fabrics if spilled

host defence mechanisms

• skin

• mucous membranes (tears, lining)

• cells in respiratory tract produce lysozymes that destroy bacteria

• macrophages trap and destroy bacteria

• goblet cells line GI tract and make it too acidic or alkaline for bacteria

• immune system has proteins that kill viruses

droplets transmission

• only travel about 1-2 meters

• can be inhaled or enter through mucus membranes

• can be picked up off of surfaces

vehicle transmission

• transmitted when contaminated food is ingested

• direct contact with contaminated blood (used needle)

vector borne transmission

• transferred to humans through a carrier (flea)

• infection occurs when bitten or stung by carrier

bacteria

• grow and reproduce outside of human cells

• need an environment with proper temperature and nutrients

• can multiply inside of host

virus

• smaller than bacteria

• can only multiply inside of host

• cannot survive in an exterior environment

fungi

• usually acquired via contact with decaying matter

• can be acquired through airborne spores

• often infect people with compromised immune systems

parasites

• live on or in another living creature

• Protozoa- single celled

• helminths- invertebrates with long bodies (worms)

virulence

the ability for an organism to invade and create disease in the host

mode of entry

most organisms need the correct mode of entry to infect

host resistance

ability to fight off infection

incubation period

• stage between exposure and symptoms

• organism multiplies during incubation

communicable period

• the period where a person can transmit the disease

• some diseases are communicable before symptoms are present

contaminated

• an object that has microorganisms on or in it

reservoir

• where organisms can live and multiply

routine practices components

• hand hygiene

• PPE

• sharps safety

• patient accommodation and transport considerations

• routine equipment cleaning

• routine vehicle cleaning and disinfection

when should hands be washed

• beginning and end of shift

• before and after patient contact

• before and after using PPE

• before invasive procedures

• after cleaning

• before leaving hospital

• before and after handling food

• before and after smoking

• after personal body functions

respirator mask should be used when

• coughing patient

• fever without a known source

• patient with communicable disease

• blood or fluid splash is likely

• when aerosolization is likely

• when cleaning after infected patient

• when cleaning large amounts of fluid

when should gloves be used

• patient has fever with no known source

• contact with membranes or non intact skin

• when non intact skin is on hands

• invasive procedures

• treating a patient with known communicable disease

• when cleaning vehicle

PPE order

• gown

• mask

• eye protection

• gloves

remove gloves first

assessment of infectious disease patients

• evaluate scene for danger

• initial assessment - ABCs

• prioritize treatment

• get history (travelling) and physical exam

• typical C/C are fever, nausea, rash, chest pain, trouble breathing

general treatment for infectious disease

• disinfect first

• first focus on life threatening

• watch for dehydration and use IV

• dispose of sharps properly

• clean everything

measles (rubeola)

• viral, high communicable

• airborne, droplets, and direct contact with secretions

• fever, conjunctivitis, and coryza

• onset of coughing, rash, and whitish grey spots on mouth

  • communicable period is when symptoms appear

rubella

• viral, droplets

• fever, headache, runny nose, swollen lymph glands, rash

• deformities of transmitted to baby deafness, retardation, cataracts, heart defects

• incubation period is 12-24 days from exposure

• infected people can remain infectious 7 days after rash appears

mumps

• viral, droplets and direct contact with saliva

• fever, swelling of one of the salivary glands, inflammation of testicles

• incubation period is 16-18 days

• communicable period lasts 9 days after swelling

• wear gloves and do routine cleaning after treatment

• work restriction will apply

chickenpox

• viral, high communicability, droplets, also vesicular fluid contact

• fever, photosensitivity, vesicular rash, scabbing of rash, vesicles

• can lead to shingles when virus takes up residence in the ganglion of a nerve

• incubation period is 10-21 days

• communicable period starts 1-2 days before rash and lasts 5 days after vesicles are apparent

• use surgical mask on patient, wear gloves

pertussis (whooping cough)

• bacterial, direct contact with discharges from mucus membranes, airborne droplets

• irritating cough, becomes paroxysmal after 1-2 weeks

• incubation period is 7-10 days

• highly communicable before paroxysmal, then negligible within 3 weeks

• patient wears mask, antibiotic treatment, good handwashing, and routine cleaning

meningitis

• bacterial (communicable) and viral (not), droplets and contact with oral or nasal secretions

• inflammation of membranes that cover brain and spinal cord (meninges)

• sudden onset fever, severe headache, stiff neck, kerning sign, brudzinski sign, photosensitivity, pink rash that becomes purple

• almost always change in mental status

• projectile vomiting

• incubation is 2-10 days

• communicable as long as bacteria is present

kerning sign

patient cannot extend at knee when thigh is flexed because of stiffness in hamstring

brudzinski sign

passive flexing of the leg on one side causes similar movement in opposite leg

tuberculosis TB

• bacterial, airborne droplets inhalation

• not highly communicable from surfaces and contact

• typical (communicable), atypical and extra pulmonary (not)

• persistent cough for over 3 weeks, nights sweats, headache, fever, fatigue, weight loss, hemoptysis, hoarseness, chest pain

• incubation period is 4-12 weeks

• wear n95, give patient mask

pneumonia

• inflammation of the lungs caused by bacteria, viruses, fungi, or another organism

• leading cause of death in paediatric patients, infants

• many types

bronchiolitis

• usually viral, airborne droplets inhalation

• infection of the lungs and airway, usually in patients 3-6 months in age

• coughing and wheezing with tachypnea and tachycardia

bronchitis

• inner walls of bronchioles become infected and inflamed

• soreness in chest and throat, congestion, wheezing, dyspnea, slight fever

• chronic bronchitis is coughing for 3 months per year, at least 2 consecutive years

laryngitis

• usually caused by viral disease, sometimes bacterial

• inflammation of voicebox from overuse, irritation, infection

• hoarseness, weak voice, sore and dry throat, cough

croup

• viral, droplets

• inflammation of larynx and airway below it

• strongest during nighttime

• lasts 3-7 days

• loud harsh cough, fever, noisy inhalation, hoarseness, dyspnea

• primarily 5 years of age or younger

epiglottis

• bacterial, droplets

• life threatening causes the epiglottis and supraglottic tissue to swell

• usually 2-7 years of age

• difficulty breathing and swallowing, with stridor and drooling

common cold

• viral, droplets

• upper respiratory infection

• cough, runny nose, sore throat, congestion, watery eyes

• no fever

respiratory syncytial virus

• viral, droplets

• leading cause of lower respiratory infection in vulnerable population

• sneezing, runny nose, nasal congestion, cough, fever

• moves to lower respiratory causing pneumonia, bronchiolitis, tracheobronchitis

• incubation period 2-8 days

• wear gloves, wash hands, routine cleaning

mononucleosis

• viral, contact with bodily fluids (SALIVA) and blood transfusion

• caused by Epstein Barr virus

• grows in epithelium of oropharynx and sheds into saliva

• incubation period is 4-6 weeks

• sore throat, fever, secretions from larynx, swollen lymph glands, malaise, anorexia, headache, muscle pain, enlarged liver and spleen

influenza

• virus, droplets

• 1 billion cases per year

• one of the top 10 causes of death in Canada

• incubation 1-4 days

• communicable from day before symptoms to 5 days after onset

• fever, shaking chills, headache, muscle pain, malaise, loss of appetite, coughing, nasal discharge, hoarseness

• patient wears mask, respirator, routine cleaning

• history of travel outside of country should be reported

gonorrhea

• bacterial, sexually, contact with pus from mucous membranes

• incubation period 2-7 days

• communicable until treated

• pus from urethra, pain urinating (male)

• mild inflammation of cervix followed by signs and symptoms of an acute abdomen

• may infect anus or throat

• gloves, thorough handwashing

syphilis

• bacterial, direct contact with infectious fluids from lesions

• can be transmitted from mother to fetus

• incubation 10 days - 3 months

• communicable is variable

• secondary infection causes patchy hair loss, skin rash, swollen lymph glands

• third stage can cause cardiac, ophthalmic, auditory or CNS complications

• gloves and handwashing

genital herpes

• chronic recurring viral illness, skin to skin contact

• type 1 (oral), type 2 (genital)

• vesicles around genitals and mouth

• incubation 2-12 days

• lesions are communicable for 4-7 days

• mother can pass to child during birth

• use gloves and handwashing

chlamydia

• bacterial, sexual contact

• asymptomatic in women at first

• pelvic inflammatory disease often occurs (women)

• may lead to epididymitis, prostatitis, proctitis, proctolitis

• perinatal infection can cause premature rupture of membranes, stillbirth and premature birth

• incubation period is 7-14 days

• communicable period is unknown

• treat with antibiotics, wear gloves and handwashing

scabies

• parasite, skin to skin contact

• incubation period 4-6 weeks

• communicable until eggs and mites are gone

• nocturnal itching, rashes on hands, wrists, axillary folds, ankles, toes, genitals, buttocks and abdomen

• wear gloves and handwashing, work restrictions may be ordered

lice

• parasitic, contact with lice or eggs

• head, body, and pubic louse

• incubation 8-10 days until hatching

• communicable as long as lice and eggs are present

• gloves, handwashing, routine cleaning

viral hepatitis

• viral,

• A fecal oral

• BC contact with bodily fluids

• 6 types, ABC account for 90 percent of cases

Hepatitis B virus infection

• viral, contact with bodily fluids

• can survive in blood for 7 days outside of body

• incubation from 60-150 days

• symptoms start at 90 days

• loss of appetite, nausea, vomiting, general fatigue, malaise, fever, abdominal discomfort

• second phase urine turns dark, jaundice, yellowing of sclera

• use gloves, get vaccinated, good handwashing

Hepatitis C virus infection

• viral, blood transfusion, less likely other bodily fluids

• incubation 2-24 weeks

• same symptoms of HBV

• most common chronic blood borne disease

• use gloves, needle safety, hand washing, routine cleaning

hepatitis d virus infection

• host needs HBV for infection

• HDV is a parasite for HBV, contact with bodily fluids

• rarely passed to fetus

• incubation 30-180 days

• blood is infectious during all stages

• use gloves, needle safety, handwashing, routine cleaning

• do not put hands where you can’t see them

hepatitis G

• usually accompanied by HBV, HCV or HIV

• transmitted through blood or blood products, rarely other fluids

• may not be an actual hepatitis virus

human immunodeficiency virs infection HIV

• viral, STD, bodily fluids

• can rarely be transmitted through blood transfusion

• HIV pathogen envelopes infected cells and attacks organs and immune systems

• 4-6 week incubation before envelope

• acute illness, malaise, swollen lymph glands, headache, rash

• use gloves, handwashing, routine cleaning, needle safety

acquired immunodeficiency syndrome AIDS

• end stage disease process caused by HIV

• makes patient very weak to bacterial, viral, and fungal infection

• incubation occurs between start of HIV to development of AIDS

• standard procedures for prevention

• if exposed take HIV test

gastroenteritis

• nausea and vomiting, fever, abdominal cramps, diarrhea

• can cause dehydration

• many types of infections and irritations in GI tract

Hepatitis a virus infection

• most common version of hep

• transmission through fecal oral route

• incubation 2-4 weeks

• communicable period starts toward end of incubation until after patient becomes jaundiced

• phase 1, fatigue, loss of appetite, fever, nausea, abdominal pain

• phase 2, jaundice, dark urine, pale clay coloured stool

• standard cleaning

hepatitis e virus infection

• developing countries

• transmission through fecal oral route, water

• can rarely be transmitted through sexual contact and transfusion

• incubation 15-60 days

• signs and symptoms are same as other hep

• standard precautions, wash infected equipment

West Nile virus

• bite from mosquito, blood transfusion

• incubation 2-6 days

• 20 percent of the time, headache fever, weakness, joint pain, vomiting, diarrhea rash

• be careful with sharps

Lyme disease

• bacterial, tick bites

• affects skin, heart, joints, and NS

• some patients asymptomatic

• incubation 3-32 days

• stage 1, round red skin lesion

• early disseminated stage, flulike symptoms

• within 2-8 weeks, meningoencephalitis, cranial and peripheral neuropathy

• cardiac involvement in untreated patients

• third phase, arthritis, memory impairment, depressed mood, severe fatigue

• wear long sleeves and pants in tick infested areas

• find and remove ticks within 72 hours

hantavirus

• viral, contact or inhalation of rodents, feces, urine, saliva

• flu-like symptoms that can escalate into life threatening breathing problems

• sudden onset fever escalates to cardiogenic shock and lung involvement

• often transmitted through inhalation

• incubation 12—16 days

• routine cleaning of vehicle

rabies

• viral, contact with saliva and mucous membranes

• causes fatal encephalomyelitis upon reaching brain

• once symptoms develop death follows in the next 7-14 days

• incubation 2-8 weeks depends on severity and location of bite

• flulike symptoms

• paralysis, mental decline, coma

tetanus

• bacterial, spores enter body through broken skin

• incubation 3-14 days

• painful muscle contractions near wound, rigid in neck, face, jaw and trunk muscles

• may require airway and ventilation support en route

• not transmissible

methicillin resistant staphylococcus aureus MRSA

• bacterial, direct contact

• incubation period 4-45 days

• may be colonized or infected

• localized skin abscesses and cellulites, empyemas, and endocarditis

• sepsis occurs with s aureus infection

• standard practices

vancomycin resistant enterococci

• bacterial, direct or indirect contact

• VRE can be found in urinary tract and blood stream infections and is prevalent in livestock

• can be colonized (can’t) or infected (can transmit)

• transmission with direct contact with wound drainage and an open cut or sore allows organism in

• use a gown if contact might be made with drainage

severe acute respiratory syndrome SARS

• viral infection, direct contact, respiratory secretions or bodily fluids

• incubation is 10 days

• dry cough, pneumonia, fever of greater than 38C, headache, discomfort, body aches

• need travel history and history of facilities that have contact with SARS

• patient should wear surgical mask, wear respirator

• notify EMS officials if made contact

• 10 day quarantine

avian influenza

• viral, direct contact with infected birds

• fever, sore throat, cough, muscle aches, eye infections

• may lead to pneumonia or severe respiratory distress

• patient should wear a mask, respirator

• antiviral drugs can be administered to reduce effects

• get immunization

middle eastern respiratory syndrome

• viral respiratory illness, direct contact with respiratory secretions

• fever, cough, shortness of breath

viral hemorrhagic fevers

• viral

• transmitted by direct contact either blood and bodily fluids

• fever, headache, muscle pain, weakness, diarrhea, vomiting

• incubation 8-21 days

• gloves, mask, eye protection, face shield, gown

zika virus

• viral, mosquitos, sexual contact, blood and tissue products

• 1 in 4 people show retro orbital pain, low fever, headaches, joint pain, swelling, rash

• incubation 3-14 days

• virus RNA can be found in serum, saliva, urine, semen, vaginal secretions

congenital zika syndrome

• defects that come after zika virus

• microcephaly, partially collapsed skull, abnormal brain development, hypertonia and spasticity and seizures, club feet, feet abnormalities

critical equipment

• items that come into contact with mucus membranes

• use of chemical sterilants is minimum

• laryngoscope blades, tracheal tubes, etc.

semicritical equipment

• items that come into direct contact with skin

• clean with solutions that claim to kill HBV

• bleach and water at 1:100

• stethoscope, uniforms, PPE, etc.

noncritical equipment

• cleaning surfaces, floors, ambulance seats, work surfaces

• hospital grade cleaner or water bleach combination

general cleaning routine

1. strip used linens and put in appropriate place

2. dispose of all used disposable equipment

3. wash contaminated areas with soap and water or designated cleaner

4. disinfect all non disposable equipment

5. clean the stretcher with germicidal solution

6. clean up all other contamination with germicidal solution

7. create a schedule for routine cleaning

8. have written procedure on how to clean each piece of equipment

9. focus on frequently touched items

modes of transmission

1. physical contact

2. droplets

3. airborne

portals of entry

• mucous membranes

• respiratory stsem

• digestive system

• broken skin

susceptible hosts

• immune deficiency

• diabetes

• burns

• surgery

• age

infectious agents types

• bacteria

• fungi

• parasites

• prions

portals of exit

• blood

• secretions

• excretions

• skin

chain of infection (no order)

• infectious agents

• reservoirs

• portals of exit

• modes of transmission

• portals of entry

• susceptible host

how to remove PPE before cleaning ambulance

• remove linen and push stretcher into hallway

• remove gloves

• wash hands

• remove gown

• wash hands

• leave room

• wash hands

• put on new gloves