Egan’s Chapter 4 Practice Questions:

 

Question Answer
What three elements that must be present for transmission of infection within a health care setting? A source (or reservoir) of pathogens, a susceptible host and a route of transmission. (Egan Pg 54)
What is the name for infections that are acquired in the hospital? Nosocomial infections. (Egan pg 54)
What is the term for inanimate objects that may serve to transfer pathogens from one person to another? fomites. (Egan Pg 55)
What precautions are used to prevent a form of contact transmission that occurs when droplets are propelled short distances(within 3ft or less through the air) Droplet Precautions. (Egan Pg 69)
What are four categories of Expanded Precautions? Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment. (Eagan Pg 68)
Hand hygiene includes both handwashing with either plain or antiseptic-containing soap and water for at least how many seconds? 15 seconds. (Egan Pg 70)
What are the precautions that are to be applied to the care of all patients in all health care settings? Standard Precautions. (Egan Pg 67)
What is the practice of grouping patients with the same infection? Cohorting. (Egan Pg 73)
What is an ongoing process of monitoring patients and health care personnel for acquisition of infection and/or colonization of pathogens? Surveillance. (Egan Pg 73)
What are methods that kill bacteria? bactericidal. (Egan Pg 57)
What is the size of droplet nuclei? 5 um or less. (Egan Pg 56)
How many infections do hospital-acquired HAIs account for annually? estimated 2 million infections.(Egan Pg 54)
What is the best choice for high-level disinfection of semicritical respiratory care equipment? glutaraldehyde. (Egan Pg 74)
Among respiratory care equipment what has the greatest potential to spread infection? large-volume nebulizers. (Egan Pg 74)
The use of what is part of routine care when there is skin care? gloves. (Egan Pg 74)
List three general barrier methods used to prevent exposure to organisms gloves, gown and goggle/mask. (Egan Pg 68)
Ventilator circuits may be used up to how many days before they need to be changed? 7. (Egan pg 68)
What type of water should be placed in the nebulizer? sterile distilled water. (Egan Pg 63)
The best way to prevent the spread of infection in the ICU is to? Wash your hands after every patient contact. (Egan Pg 54)
What should be worn to treat patients with tuberculosis? N-95 mask. (Egan Pg 72)

 

 

Question Answer
 Health Care Associated Infection (HAI)  Infections that patients acquire during the course of medical treatment. Approx 5% of patients of all patients admitted to a hospital develop an HAI.  15% of HAIs are pneumonia.
 What is the aim of infection control procedures?  – eliminate the sources of infectious agents.

 

 – create barriers to their transmission.
 – monitor and evaluate the effectiveness of control.
 What 3 elements must be present for transmission (within a healthcare setting)?
 1) a source (of pathogens)
 2) susceptible host
 3) route of transmission
 What/who are the primary sources for infectious agents in the healthcare setting?
 – Humans; however inanimate objects have also been proven to cause transmission.
 – Autogenous infection
 When a person serves as their own source of infection?  Via endogenous flora.
 Where do most nosocomial pneumonia’s occur?
 Surgical patients.  Particularly if they have had chest or abdominal procedures. In these patients normal swallowing and clearance mechanisms are impaired, allowing bacteria to enter and remain in the LRT (lower resp. tract).
 Why are patients with an artificial tracheal airway at high risk for nosocomial pneumonia?  Typically they require prolonged intubation, and may already have one or more factors predisposing them (such as COPD).  Another risk factor may be increased upper airway colonization with gram-negative bacteria.  Also, handling of these tubes increases the likelihood of cross-contamination.
 Immunocompromised Hosts  Physicians may purposely suppress a patient’s immune response with drugs (such as in organ transplant cases).  Or immunosuppression may be a result of an underlying disease such as AIDS.
 What are the 3 major routes for transmission of human sources of pathogens in the health care environment?  1) contact (direct/indirect)

 

 2) Respiratory Droplets
 3) Airborne Droplet Nuclei
 Contact Transmission
 The most common route of transmission. Two subdivisions are direct and indirect.
-Proper use of gowns & gloves-Most commonly employed to decrease spread of multidrug-resistant organisms, such as Clostridium difficile
 Direct Contact Transmission  Occurs when a pathogen is transferred directly from one person to another.  This occurs less frequently than indirect but is more efficient.  I.e.) development of RSV bronchiolitis in a bone marrow transplant recipient owing to transmission of the virus from an ill health care worker who did not perform appropriate handwashing before care.
 Indirect Contact Transmission   Most frequent mode of transmission in the health care environment > involves the transfer of a pathogen through a contaminated intermediate object or person.  Most commonly occurs due to poor or the lack of handwashing.
 Fomites  Inanimate objects that serve to transfer pathogens from one person to another.
 Sources of infectious agents:  – Humans are the primary source.
– Inanimate objects (e.g., contaminated medical equipment) can spread infection.
– Individuals in the hospital capable of being source include:

 

   • Workers
   • Visitors
   • Patients
 How can the health care worker interrupt the route of transmission of pathogens?
 – Special equipment handling
 – Barrier/isolation precautions using both standard & transmission based precautions
 Standard Precautions
 Intended to be applied to the care of all Px in all health care settings all the time.
Combine major features of Universal Precautions & Body Substance Isolation to be applied to patients in all health care settings, all the time.
 Standard precautions apply to:  Blood, all body fluids, nonintact skin, and mucous membrane.
 PPE  Personal Protective Equipment.  Refers to various barriers and respirators used alone or in combination to protect mucous membranes, skin, and clothing from contact with infectious agents.
 Gloves  Must be sterile whenever performing invasive procedures.
 Masks  Protect mucosal surfaces against splashes or sprays but should not be confused particulate.
 N-95 Respirator  Intended for diseases that could be airborne transmitted.
 Gowns  Provide barrier protection & can prevent contamination of clothing & exposed body areas
 Droplet Precautions
 – To prevent form of contact transmission that occurs when droplets are propelled short distances, such as influenza > Generated coughing, sneezing, suctioning, bronchoscopy, & cough induction
 – Surgical mask must be worn
 Airborne Infection Isolation
 – Isolation techniques intended to reduce risk of selected infectious agents transmitted by “small droplets” of aerosol particles, such as M. tuberculosis
 – Use of N-95 respirator
 – Room must be negative pressured, 2 air exchanges per hour, & use HEPA filters
 – Patient Placement and Transport
 Single occupancy room ideal
 – Cohorting: grouping patients same infection
 – Limit transport of patients contagious diseases
 – During transport: patient needs to wear appropriate barrier protection (masks, gowns, impervious dressings) consistent w/ route & risk for transmission
 Cohorting
 The act of grouping patients with the same infection together to confine care geographically and prevent transmission to other patients.
 Cleaning
 – Cleaning is the first step in all equipment processing >Involves removing dirt & organic material
 – Failure to clean equipment properly can render all subsequent processing efforts ineffective
 – Soaps & detergents need to be used
 – Non-critical items, such as commodes, intravenous pumps, & ventilator surfaces, must be thoroughly cleaned & disinfected before use another patient
 Disinfection  – Describes a process that destroys the vegetative form of all pathogenic organisms on an inanimate object except bacterial spores.

 

 – Disinfection can involve either chemical or physical methods.
– Pasteurization is the most common physical method.
 Chemical Disinfection  – Chemical disinfection involves application of chemical solutions to contaminated equipment or surfaces

 

 – Equipment must be immersed in solution for set period of time
 – Many chemical methods used to disinfect respiratory care equipment
 – Labels should be read carefully & instructions properly followed during use
 Sterilization
 • Destroys all microorganisms
 • Can be achieved w/ physical & chemical approaches
 • Steam sterilization is most common & easiest
 • Low-temperature sterilization technologies include ethylene oxide: colorless & toxic gas
 • Medical devices contacting with sterile body tissues or fluids are critical items & should be sterile before use
 Steam Sterilization  Moist heat in the form of steam under pressure is the most common, most efficient, and easiest sterilization method. (autoclaving=steam under pressure).
 What are some equipment handling procedures that help prevent the spread of pathogens?  – maintenance of in-use equipment

 

 – processing of reusable equipment
 – application of one-patient use disposables
 – fluid and medication precautions
 What are some in-use respiratory care equipment that can spread pathogens?  Nebulizers, ventilator circuits, bag-valve-mask devices, and suction equipment. (also oxygen and pulmonary function equipment)
 3 major issues of disposable equipment:  1) cost

 

 2) quality
 3) reuse (i.e. if people try to use the item again>>raises significant safety concerns)
 Surveillance   – A tool to provide HAI data on patients to provide outcome measurements either to ensure that there is no ongoing problem or to detect problems and intervene to prevent pathogen transmission.

 

 – Common for infection prevention programs to oversee hand hygiene & standard precautions adherence observations
 Name three infections that are spread via direct contact transmission:
 1) Hep. A
 2) HIV
 3) Staphylococcus
 4) Enteric Bacteria
 Name 2 infections spread by indirect contact transmission:
 1) Pseudomonas aeruginosa
 2) Enteric bacteria
 3) Hep B and Hep C
 4) HIV
 Name 3 infections spread by droplet transmission:  – pneumonia

 

 – Neisseria meningitides (pneumonia)
 – Diptheria
 – Pertussis
 – Influenza
 – MMR
 Name 3 infections spread by airborne transmission:  – Aerosols: Legionellosis

 

 – Droplet nuclei: TB, Varicella, Measles, Smallpox
 What are some factors that can enhance susceptibility to infection?  Diabetes, extremes of age, obesity, underlying HIV infection.
 Which patients are more at risk for pneumonia?  Elderly, obese, COPD, and patients with an artificial airway.
 What is the most difficult and least feasible approach to infection control?  Decreasing host susceptibility.
 What vaccine does OSHA mandate that employers provide?  Hepatitis B Vaccine
 What is the best way to decrease host susceptibility to a device-related infection?
 – Limit device use
 – Ensure that devices are placed and maintained properly
 Respiratory ‘Etiquette’  1) Education
2) Signage
3) Source Control
4) Hand Hygiene
5) Spatial Separation

Question Answer
 1.Among respiratory care equipment what has the greatest potential to spread infection?  Large-volume nebulizers. (Egan Pg 74)
 2.The best way to prevent the spread of infection in the ICU is to?  Wash your hands after every patient contact. (Egan Pg 54)
 3.Hand hygiene includes both handwashing with either plain or antiseptic-containing soap and water for at least how many seconds?  15 seconds. (Egan Pg 70)
 4.How many infections do hospital-acquired HAIs account for annually?  Estimated 2 million infections (Egan Pg 54)
 5.List three general barrier methods used to prevent exposure to organisms.  Gloves, gown and goggle/mask. (Egan Pg 68)
 6.The use of what is part of routine care when there is skin care?  Gloves. (Egan Pg 74)
 7.Ventilator circuits may be used up to how many days before they need to be changed?  7. (Egan pg 68)
 8.What are four categories of Expanded Precautions?  Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment. (Eagan Pg 68)
 9.What are methods that kill bacteria?  Bactericidal. (Egan Pg 57)
 10.What are the precautions that are to be applied to the care of all patients in all health care settings?  Standard Precautions. (Egan Pg 67)
 11.What is the size of droplet nuclei?  5 μm or less. (Egan Pg 56)
 12.What is an ongoing process of monitoring patients and health care personnel for acquisition of infection and/or colonization of pathogens?  Surveillance. (Egan Pg 73)
 13.What is the best choice for high-level disinfection of semicritical respiratory care equipment?  Glutaraldehyde. (Egan Pg 74)
 14.What is the name for infections that are acquired in the hospital?  Nosocomial infections. (Egan pg 54)
 15.What is the practice of grouping patients with the same infection?  Cohorting. (Egan Pg 73)
 16.What is the term for inanimate objects that may serve to transfer pathogens from one person to another?  Fomites. (Egan Pg 55)
 17.What precautions are used to prevent a form of contact transmission that occurs when droplets are propelled short distances(within 3ft or less through the air)?  Droplet Precautions. (Egan Pg 69)
 18.What should be worn to treat patients with tuberculosis?  N-95 mask. (Egan Pg 72)
Question Answer
What do infection control procedures aim to do eliminate the sources of agents, create barriers to their transmission, monitor the effectiveness of control
3 elements present in spread of infection source of pathogens, susceptible hosts, route of transmission
host factors increasing the chance of infection are Poorly controlled diabetes, increased age, chemo, placement of tubes and catheter
Sources of infectious agents Humans, inanimate objects, workers In hospital
Steps in decreasing host susceptibility Shots, ventilators, limit the use of devices, prevention bundles
Steps to interrupting the route of transmission Special equipment handling, barrier precautions, disposable equipment
Standard precautions apply to Blood, all body fluids, nonintact skin, mucous membranes
What is involved in PPE Gloves, masks, n-95, gowns
contact precautions Gowns, gloves, most common to reduce the spread of drug-resistant organisms
droplet precautions Generated with coughing, sneezing, suctioning bronchoscopy and cough induction and surgical mask must be worn
Airborne infection isolation Isolation technique intended to reduce risk of selected small droplet such as tuberculosis, use of n-95 respirator room must be negatively pressured and 2 air exchanges per hour and use HEPA filters
disinfection Destroys vegetative forms of all pathogens except bacterial spores, pasteurization is most common physical method
sterilization Destroys all microorganisms, steam sterile. Is the most common and easiest

 

Question Answer
 1. Importance of surveillance  To ensure that there is no ongoing problem or to detect problems and intervene to prevent transmission of pathogens in the health care environment.
 2. What does each letter in SOAP stand for?  S = Subjective (patient’s complaints)

 

 O = Objective (results of physical exam, lab tests, ABGs,
 chest radiograph, etc.)
 A = Assessment (What is the problem?)
 3. List the 11 general rules for medical documentation.  1. Entries should be printed or handwritten.

 

 2. Do not use ditto marks.
 3. Do not erase.
 4. Record each patient interaction and sign the entry.
 5. Document patient complaints.
 6. Do not leave blank lines in the chart.
 7. Use standard abbreviations only.
 8. Use the present tense.
 9. Use proper spelling.
 10. Document all important conversations.
 4. Describe respiratory hygiene/cough etiquette.  • Education of patients & employees

 

 • Posted signs
 • Source control measures (covering mouth/nose, or using surgical mask)
 • Hand hygiene
 5. Nosocomial infections  INCORRECT: You gave no answer

 

Question Answer
 1. 4 categories of expanded precautions.  Transmission based, airborne infection isolation, protective environment, patient placement and transport.
 2. Name the three risk categories applicable for medical equipment  Critical, semi-critical, non-critical.
 3. Disinfection high-level  Inactivation all microorganisms except bacterial spores (with sufficient exposure times, spores may also be destroyed)
 4. Name three infection control strategies.  1) Interrupting routes of transmission
2) eliminating source of pathogens
3) specialized equipment processing
 5. How to minimize fire hazard via toys that create a spark?  Keep them away from oxygen use