cnt exam

what is the purpose of CNT?

reduce risk of spreading infection from patient to patient, from patient to ourselves, or from ourselves to patient.

Reason for CNT

Reduce risk of accidents

Help maintain public safety

Help meet medical, legal and ethical requirements of healthcare workers

Sterilizatation

the process of destroying ALL microbial life (including viruses) via sterilants (chemicals) or sterilizing methods.

Disinfection

the process that REDUCES the number of microbes on inanimate objects. Disinfected objects are considered "clean"

Antiseptic

Chemicals used to reduce microbes on living tissue. They are used on patients and practitioners.

Disinfectants

Chemicals used to reduce microbes on inanimate objects. They are used on tools and equipment.

Aseptic Techniques

used to prevent infection during invasive procedures, such as for surgery, or other invasive procedures or dressing wounds.

Clean techniques

used by acupuncturists during our needle insertion activities.

Clean Field

Section of a work surface, including the skin of and surrounding the targeted acupoint, that has been prepared to manage acupuncture equipment in a way to protect the sterility of acu needles.

Contraindications of needling

Excessively elevated blood pressure because of the risk of stroke

Contraindications of needling

Intoxicated or chemically mind-altered state of you or your patient whether from illicit or prescription meds, alcohol or mental function.

Contraindications of needling

Patient refusal

Contraindications of needling

Wound at specific site of insertion (infection, bruise, rashes, etc.)

Precautions of needling

Pregnant women

Precautions if needling

Be aware if your patient is on blood thinners.

Precautions if needling

History of syncope/fainting

Precautions if needling

Know if your patient has compromised ability to sense pain, temp, pressure, etc.

Precautions if needling

Know anomolies and general health history of your patient.

Precautions if needling

Time considerations

True de Qi sensation

Felt when the needle is seated in the muscle layer, not the skin layer. That is, in the channel not the wei qi.

How should de qi feel?

NOT excruciating pain. If it is excruciating, then something is wrong.

If there is no sensation when the needle has punctured, you'll have likely

NOT contacted the qi.

Patient de qi sensation descriptors

Dull ache, numbness, distention, heavy feeling, tight feeling, cold feeling, warm feeling, electric shock that doesn't last long, radiation to another location.

Practitioner De Qi sensation descriptors

Heavy, tight pressure, perhaps slight muscle twitch (good visual cue), gentle reddening of the surrounding tissue, grasped or "fish tugging on the line" sensation.

Theraputic effects of TDP Lamps

Dilating blood vessels and increasing blood flow and oxygen saturation.

Accelerating the decomp of dead or unstable cells

Enhancing white blood cell function, increasing immune response and stimulating hypothalamus, which controls the production of neurochemicals, which control sleep, mood, pain and bp.

TDP lamp head is usually how far away from body

8 inches awa.

Mild stimulation with TDP lamps should be used ….

around the eyes

if there are metals inside the irradiated part of body

when treating chillblain and ulcer as well as infants.

Increased herb/drug absorption is seen with what?

With the use of TDP lamps simultaneously with linaments.

Warning with TDP lamp

Unplug when installing or dismantling device

Warnings with TDP lamp

The irradiation head will be considerably hoe when operating. Make sure that you move the lamp head out of range of contact with your patients when they move to get off table.

Warnings with TDP lamps

Never put fingers and other objects into the protective wire mesh of the head

Warnings with TDP lamps

make sure there are no covers over the head

Hot and cold pack warnings

Be careful combing with liniments or herbs. Instruct patient on amount of time to leave a pack on the skin.

Chronic Carrier

Someone who harbors infectious agents for a year or longer after recovery. 90% of newborns infected at birth with HBV become chronic carriers; up to 10% chronic carriers when infected after age 5

Convalascent carrier

Someone who appears to have "recovered" from an illness, but is still capable of transmitting the infectious agent to others.

Inapparent "subclinical" carrier

Someone who has been infected with a pathogen and will eventually, but does not yet exhibit signs nor sypmptoms of the illness. An example is HIV

"Healthy" "asymptomatic" carrier

Someone who never develops the disease even though they carry the pathogen

Acute clinical cases

In this state, we're likely to be obviously sick and more readily diagnosed than reservoirs in a carrier state. Consequently, we may be limited in activities and contact with others.

Reservoir

Place where infectious agents live and reproduce so that it can be transmitted.

Portals of exit

Non-intact skin

Orifices of the respiratory system

Orifices of the genito-urinary system

Orifices of the alimentary tract

Transplacental

Human body fluids

Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

OPIMS

1) Human body fluids

2) Any unfixed tissue or organ

3) HIV-containg cell or tissue cultures, organ cultures and HIV or HBV containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV

What bodily substances are NOT on the OPIM list?

tears, sputum, feces, urine, sweat, vomit, breast milk. Not on the list because they are not known to carry or support bloodborne pathogens of concern to us.

Direct transmission

Person-to-person contact where pathogenic factor needs no contaminated intermediate object to facilitate the passage.

Indirect Transmission

Requires a contanimated object to help make the connection between source and susceptible host.

Droplet transmission

Larger particles are expelled from the respiratory tract when a person talks, coughs, sneezes and tend to impact receptors within a yard of the mouth/nose from which they were ejected.

Airborne transmission

This route refers to the very small particles (fine mists and contaminated dust particles) that may remain airborne long enough for inhalation by another person.

Common Vehicle Transmission

Contamination of everyday things that are shared by a larger community and normally assumed to be clean that are in fact, not clean. Diseases spread by contaminated food or water.

Vector Transmission

Spread of diseases spread by insects and animals.

Parenteral Transmission

Refers to the penetration into the skin by an object, such as a needle, knife, etc.

Autogenous Infections

Occurs from pathogens that reside in or on a person's body.

Cross-Infections

Occur from pathogens that are not resident in or on our body. This can be from direct or indirect contact.

Direct acquisition of cross infection

Can occur when we come in direct contact with the blood or bodily fluid of a person who carries a particular virus or bacteria.

Indirect Acquisition of cross infection

Can occur when we come in contact with a pathogen that has been deposited on an inanimate object, such as HBV tainted blood left on a guasha spoon.

What is our #1 defense against disease?

Intact skin

Contamination

The introduction of environmental contaminants or disease-causing microbes into or onto previously clean or sterile objects

With E-Stem, DON'T do what?

-Don't interfere with implanted electrical stimulators

-Do not cross the center line of the body

-Never combine plated needles, or solid needles made from soft metals

Incubation for Hepatitis A

15-50 Days

Transmission of Hepatitis A

Fecal-Oral

Onset of Hepatitis A

Abrupt

Vaccine for Hepatitis A

Yes

Is Hepatitis A Chronic?

No

Incubation of Hepatitis B

50-180 Days

Transmission of Hepatitis B

Bloodborne

Onset of Hepatitis B

Insidious

Vaccine for Hepatitis B?

Yes

Is Hepatitis B chronic?

Depends on the age group

Incubation of Hepatitis C

20-90 days

Transmission of Hepatitis C

Bloodborne

Onset of Hepatitis C

Insidious

Vaccine for Hepatitis C?

No

Is Hepatitis C chronic?

60-70% is chronic

Incubation for Hepatitis D

Unknown

Transmission of Hepatitis D

Unknown

Onset of Hepatitis D

Unknown

Vaccine for Hepatitis D?

No

Is Hepatitis D chronic?

Unknown

Incubation for Hepatitis E

15-60 Days

Transmission of Hepatitis E

Fecal-Oral Route

Onset of Hepatitis E

Abrupt

VAccine for Hepatitis E

No

Is Hepatitis E chronic?

No

Autogenous Infections

Caused by an infectious agent that the patient is already carrying. An example would be peritonitis following a deep abdominal insertion that punctures the peritoneum and intestine.

Cross-Infections

Caused by pathogens acquired from another person or by the environment. May be acquired directly or by transfer

Hepatitis A symptoms

Abrupt onset with symptoms that include abdominal discomfort, loss of appetite, fatigue, nausea, dark urine, and jaundice. Symptoms usually last less than 2months. Individuals who have had HAV can NOT be reinfected.

HBV early symptoms

Often begin with mild flu-like signs and symptoms such as a fever, general malaise, or insidious onset of anorexia and abdominal pain. Other sx include chills, nausea, joint pains, rash and diarrhea.

What is the most common chronic bloodborne viral infection in the United States?

Hepatitis C

Chronic Persistent Carrier of Hepatits

Someone who is Asymptomatic or has minimal symptoms but can continue to infect others.

Chronic Active Carrier of Hepatitis

Has progressive symptomatic disease that continues to damage the liver.

In health care settings, what is the risk of infection from exposure to contaminated blood for HBV?

30%

In health care settings, what is the risk of infection from exposure to contaminated blood for HIV?

0.3%

What are some of the symptoms associated with contraction of HIV?

Fever, malaise, body aches, maculopapular rash, lymphadenopathy, and headache.

How is MRSA spread?

This organism is spread by skin-to-skin contact and can be readily transmitted from patients to health care providers, staff and other patients.

What is THE most important procedure fro preventing an infection in a health care setting?

Hand washing

Transient infectious agent

Those that are picked up from one patient and possibly carried to another.

Resident infectious agent

Agents which lodge deeper in the skin, present additional risk for an immunocompromised patient.

Why is alcohol above 70% concentration not appropriate for preparing a patient's skin for needle insertion?

Because the alcohol will evaporate too quickly to have an antiseptic effect if above 70%.

When needling in thoracic and back regions, what should you be cautioned of?

Muscles are sometimes thin and important viscera such as the heart, lungs, liver and spleen are in close proximity. It is advisable to puncture cautiously, preferably at an appropriate angle as indicated in standard texts.

The head and facial region should generally be punctured how?

Superficially or obliquely, as the tissues and muscles are thin in those areas.

HBV viruses can survive for how long?

They can survive on surfaces for more than one week at room temperature.