Egan Chapter 4: Infection Control (Workbook)

What is a healthcare associated infection (HAI)?

Infections that patients acquire during the course of medical treatment.

How many Hospital-acquired infection occur? How HAIs lead to death annually?

Hospital-acquired infections (HAIs) account for 1.7 million infections & 99,000 excess deaths annually

What percentage of patients in a hospital will acquire an HAI? How many ventilated patients will acquire an HAI?

bout 5% of patients admitted develop an HAI. About 25% of mechanically ventilated patients develop pneumonia, & 30% (of those 25%) will die

Why is knowledge regarding HAIs important to our profession?

Because many of the infections involve the lung and many are fatal

List three elements that are required for these infections to develop

Source of reservoir, Susceptible host, and Route of transmission

A susceptible host may be elderly, have HIV, or be undergoing chemotherapy, but we can still reduce host susceptibility by focusing on employee health and chemoprophylaxis. List five vaccinations that might help you decrease the risk of transmitting an HAI.

Rubella =Measles =Varicella=Hepatitis B=DTP=Influenza

Respiratory therapists must know the routes of disease transmission so we can avoid infection. What are the three major routes? Give an example of each.

Contact(direct & indirect); Respiratory Droplet(Coughing, sneezing, talking);

Airborne droplet:(Tuberculosis, measles, SARS)

Explain the difference between droplet versus airborne transmission

Droplets Transmission- from infected person, propelled short distances (up to 3 feet) enter the susceptible host through coughing, sneezing, talking. Airborne transmission-Small particles carrying pathogens, Particles can be widely dispersed by air currents before being inhaled by host (tuberculosis, measles, SARS)

Define cleaning

Removal of all foreign material (e.g., soil, organic material) from objects.

Define disinfection (general term)

Inactivation of most pathogenic organisms, excluding spores

Define disinfection-low level

Inactivation of most bacteria, some viruses, and fungi, without destruction of resistant microorganisms such as Mycobacterium tuberculosis or bacterial spores

Define disinfection-intermediate level

Inactivation of all vegetative bacteria, most viruses, most fungi, and M. tuberculosis, without destruction of bacterial spores

Define disinfection-high level

Inactivation of all microorganisms except bacterial spores (with sufficient exposure times, spores may be also be destroyed)

Define sterilization

Complete destruction of all microbial life

How do you disinfect and sterilize these items:

Laryngoscope

Humidifier

Mechanical ventilator

Laryngoscope: Glutaraldehyde, High level disinfection

Humidifier: Liquids like glutaraldehyde, high level

Mechanical ventilator: Wipe w/alcohol, intermediate disinfection

List three general barrier methods to prevent exposure to organisms. Describe a situation or identify an organism for which you (as a respiratory therapist) would need this type of protection.

Gloves: Touching body fluids or mucous membranes

Gown: During procedures

Goggles/mask: Procedures like suctioning that might splash

________ is the best choice for high-level disinfection of semicritical respiratory care equipment

Glutaraldehyde

Among respiratory care equipment, ________ have the greatest potential to spread infection

Large volume nebulizers

Always use _________ fluids for tracheal suctioning and filling nebulizers and humidifiers

Sterile

Wear __________ and _________ during any procedure that can generate splashes or sprays of body fluids

Masks, Goggles

The use of ________ is part of routine care when there is skin contact

Gloves

The maximum duration of time that ventilator circuits can be used safely is __________

Unknown

You work in the surgical intensive care unit (ICU) of a large urban hospital. Over the past 2 days, a number of patients in the unit have developed serious Staphylococcus aureus infections.

Why do postoperative patients have an increased risk of infection?

Surgical incision, pain, anesthesia, intubation, and narcotics all impair host defenses

You work in the surgical intensive care unit (ICU) of a large urban hospital. Over the past 2 days, a number of patients in the unit have developed serious Staphylococcus aureus infections.

What is the most common source of S. aureus organisms?

Skin of visitors and health professionals; Mini Clini (contact transmission)

You work in the surgical intensive care unit (ICU) of a large urban hospital. Over the past 2 days, a number of patients in the unit have developed serious Staphylococcus aureus infections.

Identify three ways to disrupt the route of transmission in this situation.

Rigorous handwashing, Use of gloves, and Isolate the infected patients

During the third day of your clinical rotation, you are assigned to a therapist who has an extremely heavy workload on a medical floor in the hospital. The therapist puts on gloves for each patient contact and asks you to do so also. When you go to wash your hands after the first treatment, the therapist tells you, "We don't have time for that, and besides the gloves will keep our hands clean."

Explain the role of gloves in protecting practitioners and preventing the spread of infection.

Gloves protect caregivers from contamination when contacting patients' blood and body fluids. Gloves also protect patients from bacteria that colonize the caregivers' hands. You still need to clean or wash your hands, because gloves may have very small defects, and you may contaminate your hands when removing the gloves.

What does the CDC say about cleaning your hands in regards to washing? Are there any alternatives?

When your hands are soiled, you need to wash. Otherwise you can use alcohol-based hand cleaners.

A serious tuberculosis outbreak occurs in a local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital or treatment.

By what route does tuberculosis spread?

Airborne

A serious tuberculosis outbreak occurs in a local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital or treatment.

When transporting these patients out of the emergency department, what action should you take?

Patients should be wearing masks, preferably specialized masks for use with TB

A serious tuberculosis outbreak occurs in a local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital or treatment.

What kinds of precautions should be taken to prevent the spread of infection once these patients are admitted?

These patients should be placed in special isolation rooms

A serious tuberculosis outbreak occurs in a local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital or treatment.

What special guidelines exist in regard to cough-inducing and aerosol-generating procedures for patients with active tuberculosis?

Only perform these procedures if essential. Perform the procedures in special rooms or enclosures designed to meet ventilation requirements for airborne isolation. Patients should be instructed to cover their mouth and noses with tissues while coughing

A serious tuberculosis outbreak occurs in a local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital or treatment.

What other concerns do you have working with these patients?

Because these are prisoners, there are additional concerns regarding practitioner safety and maintenance of security

A serious tuberculosis outbreak occurs in a local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital or treatment.

What should you do if enough private rooms with airborne precautions are not available for this group of patients?

3ft spatial separation

A 72 year old female patient with COPD has a tracheostomy tube in place following prolonged intubation and mechanical ventilation. She is currently in the medical intensive unit. After you take her off the ventilator, you will need to set up a heated aerosol system with FiO2 of 40%.

What type of water should be placed in the nebulizer?

A. Distilled water

B. Tap Water

C. Normal Saline Solution

D. Sterile distilled water

D

To help lower the risk of nosocomial infection when using heated aerosol systems, the respiratory therapist should do which of the following?

A. Label the equipment with the date and time it is started

B. Avoid draining the tubing too prevent contamination

C. Use aseptic technique during the initial setup

D. Use a filter or heat and moisture exchanger (HME) to reduce airborne bacteria

A, C

The best way to prevent the spread of infection in the ICU is to

A. ensure that sterilized equipment is used

B. wash your hands after every patient contact

C. wear gloves when you come in contact with body fluids

D. isolate infected patients

B

One of your fellow students comes to clinical rotation with a cold. He asks you not to tell your clinical instructor because missed clinical days are hard to make up. What is your response to this situation? What are the potential problems to this situation?

This situation presents another opportunity for discussion of ethics and for review of your program's clinical policies.

The college recommends that you get immunized against hepatitis B before attending clinical rotation. The consent form lists a number of side effects of the vaccine, and the vaccine is expensive. What are the pros and cons of vaccines? What will you choose?

Some programs or colleges offer low-cost vaccinations. The risk of hepatitis B far outweighs the risk of the vaccine. Egan says: All RCPs should be immunized. Students who have concerns should talk to their instructors.

Explain respiratory hygiene/cough etiquette. what are the five elements of this concept?

Covering the mouth and nose during coughing and sneezing.

Using facial tissues to contain respiratory secretions, with prompt disposal into a hands-free receptacle.

Wearing a surgical mask when coughing to minimize contamination of the surrounding environment.

Turning the head when coughing and staying at least 3 feet away from others, especially in common waiting areas.

Disinfecting hands after contact with respiratory secretions