Infection Control - Exam 2

Front 1

Who does the OSHA guidelines protect?

Back 1

employee

Front 2

What areas is OSHA concerned about?

Back 2

bloodborne pathogen standards

sharps safety (use of devices and record keeping

exposure control plan to reduce the risk of "exposure"

Front 3

Who does the CDC guideline protect?

Back 3

patient and employee from infection transmission`

Front 4

What is infection?

Back 4

It is the entry and multiplication of infectious agent or pathogen in host tissues and causes cell injury (symptoms)

Front 5

What is colonization?

Back 5

it means that the pathogen is present, but does not cause cell injury

Front 6

What is symptomatic infection?

Back 6

it means that pathogens multiply and caue clinical signs and symptoms

Front 7

What does communicable or contagious mean?

Back 7

it means that it can be transmitted from one person to another

Front 8

Explain the chain of infection.

Back 8

1st - infectious agent
2nd - Reservoir
3rd - Portal of exit
4th - Mode of transmission
5th - portal of entry
6th - host

Front 9

What are some means for transmission for infection?

Back 9

contact - direct or indirect
droplets - sneezing or suctioning
airborne - dust / droplets remain in air
common vehicle - equip, food, water
vector - mosquito / rat

Front 10

What are the infectious process / stages?

Back 10

Incubation - time of exposure to time of symptoms

Prodromal - time from general symptoms to specific symptoms

Illness - symptoms of specific disease

Convalescence - acute symptoms gone - RECOVERY phase

Front 11

Why are patients in a healthcare facility at higher risk for infection?

Back 11

because their immune systems are compromised

Front 12

What are some of the body defenses against infection?

Back 12

low vaginal pH, skin, antibodies, tears, saliva, mucous, WBC

Front 13

Why are older patients at greater risk of infection?

Back 13

decline in the immune system - slowed overall immune response

less capable of producing lymphocytes to combat challenges & when they do their duration is shorter and fewer cells are produced

poor nutrition, unintentional weight loss, low serum albumin levels

stress, depression and poor social support

Front 14

What are the three different types of healthcare associated infections? (previously nosocomial)

Back 14

Iatrogenic - results from diagnostic or therapeutic procedure (gastro endo)

Endogenous - normal flora become altered and overgrowth occurs (c. diff)

Exogenous - organism present outside of clients normal flora (water in MX)

Front 15

What are the major sites for infection?

Back 15

eyes, nose, mouth, ears, urinary tract, lungs, surgical site

Front 16

Assessment for risk of infection includes a thorough inestigation in what areas of the patient?

Back 16

past diseases, travel history, immunizations, vaccinations, status of defense mechanisms, client susceptibility (age, stress), clinical appearance (how does patient look), lab results (neutrophils (WBC) respond first and will be elevated

Front 17

Nursing process R/T...what would you use for risk for infection?

Back 17

impaired primary/secondary defense

invasive procedure

malnutrition

chronic disease

Front 18

Nursing process GOAL...

Back 18

patient will not develop s/sx of infection of wound, lungs, urine

Front 19

Nursing process OUTCOME...

Back 19

what measurable criteria tell you pt does not have an infection
(ex pt remains afebrile, lungs clear, urine clear - no pain or burning,

Front 20

Nursing process INTERVENTION...
when planning consider...

Back 20

control of organism transmission
control or elimination of infectious agents
control or elimination of reservoirs
control of portals of entry

Front 21

What is asepsis?

Back 21

absence of pathogenic (disease producing) microorganisms

Front 22

What are aseptic techniques?

Back 22

procedures that assist in reducing the risk for infection or infection transmission

medical asepsis - hand hygiene, gloves, cleaning the enviro regularly
surgical asepsis -

Front 23

What is the purpose of medical asepsis?

Back 23

to reduce the number of microorg present and prevent transmission

Front 24

What is the difference between medical asepsis and surgical asepsis?

Back 24

medical is clean technique and
surgical is sterile - absence of microorganisms

Front 25

CDC recommendations for handwashing procedure if hands are visibly soiled?

Back 25

Use regular or antimicrobial soap for 10-15 seconds per policy using friction

Front 26

CDC recommendations for handwashing procedure if hands are NOT visibly soiled?

Back 26

Use alcohol-based waterless cleanser per manufacturer’s recommendation for routine decontamination of hands

Front 27

Medical asepsis - personal hygiene?

Back 27

Hair tied back
Nails short (1/4 inch)– no artificial nails
Minimal jewelry (post earrings, wedding band)

Front 28

Medical asepsis - unit controls?

Back 28

Personal Protective Equipment PPE
Separate clean & dirty
Carry linens away from body
Blood/body fluid = red bags

Front 29

What is surgical asepsis?

Back 29

absence of microorganisms.
Maintain sterility of anything that’s going to enter client’s body (except thru GI tract)

Front 30

Surgical asepsis - parenteral meds?

Back 30

Parenteral medications, needles, insides of syringes, ends of tubing, urinary catheters

Front 31

How do you tell if something is sterile?

Back 31

If it is closed and in tact it is sterile…keep eyes on it at all times

Front 32

Disease Transmission - which organisms are of greatest concern?

Back 32

Bloodborne

Front 33

Which bloodborne pathogens can be found in blood or body fluids?

What precautions are used to protect HCW from these?

Back 33

Hep A, B, C & HIV

Standard precautions

Front 34

Different types of isolation used to prevent transmission of some types of organisms - what is used for MRSA and VRSA

Back 34

must use protective equipment and standard precautions

Front 35

Standard Precautions -
Use PPE for all clients if risk of contact with:

Back 35

blood or body fluids
secretions, excretions (except sweat)
non-intact skin, mucous membranes
contaminated equipment

Front 36

Personal protective equipment
When should you wear?

Back 36

Gloves – blood and body fluids

Mask & Goggles – blood & body fluids

Gowns – trauma, surgery, C dif, certain organisms

Shoe covering / leg covering – blood & surgical procedures

Front 37

Standard precautions - Other infection control measures

Back 37

Discard single use items appropriately
Clean & disinfect re-usable equipment following facility policy
Leakproof bags for linen
Prevent skin, mucous membrane contact
Prevent uniform contact
Don’t throw on floor

Front 38

What are the different signs outside of rooms indicating precaution?

Back 38

Airborne – Droplet nuclei smaller than 5 mcg; measles; chickenpox (varicella); disseminated varicella zoster; pulmonary or laryngeal TB
Private room, negative-pressure airflow of at least 6-12 air exchanges per hour via HEPA filtration; mask or respiratory protection device

Droplet – Droplets larger than 5 mcg; being within 3 feet of the client; diphtheria (pharyngeal); rubella; streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young children; pertussis; mumps; mycoplasmal pneumonia; meningococcal pneumonia or sepsis; pneumonic plague
Private room or cohort clients; refer to the facility policy for cohorting clients
Mask or respirator is required; refer to facility policy

Contact – Direct client or environmental contact; colonization or infection with multidrug-resistant organism (MDRO) such as VRE and MRSA, Clostridium difficile, or respiratory syncytial virus (RSV); draining wounds where secretions are not contained; scabies
Private room or cohort clients; refer to the facility policy for cohorting clients; gloves, gowns

Protective – Allogeneic hematopoietic stem cell transplants
Private room, positive-pressure room with 12 or more air exchanges per hour, HEPA filtration for incoming air, respirator mask, gloves, and gowns

Front 39

Reduce reservoirs of infection by:

Back 39

Bathing – remove drainage, secretions, perspiration
Change dressings if wet or soiled
Keep drainage tubes patent
Moisture-resistant bags for contaminated articles
Tissues, dressings, linens
Hold away from uniform
Needles or sharps
Use safety features
Dispose of directly in sharps container
Keep table surfaces clean & dry
Keep bottled solutions tightly capped , date when opened & discard per facility policy
Drainage bags/bottles – empty every shift or dispose of entire bottle per facility policy.
Never raise drainage reservoir above site being drained unless it is clamped (e.g. foley bags)
Use good handwashing & standard precautions, PPE as necessary

Front 40

How do you know that Infection control measures worked?

Back 40

Compare the client’s actual response with expected outcomes.
If goals are not achieved, determine what steps must be taken.
Documentation of the client's response to therapy is of paramount importance.

Front 41

Patient safety - Reducing risk of patient injury an important nursing role.
How do we do this?

Back 41

Assess for actual & potential safety risks R/T
Developmental stage, lifestyle
Environmental risks in hospital &/or homecare setting
Underlying illness, symptoms, med SE
See Box 38-3 p. 818 for Safety Assessment
Develop processes to reduce risk of patient injury (as well as liability risk)

Front 42

In adults, many safety risks related to lifestyle...name some.

Back 42

Excessive alcohol – increased risk liver disease, MVA

Smoking - increased risk of CV, pulmonary disease

Excessive stress - increase risk of accident, illness

Sexual practices – risk of HIV, Hepatitis, other STDs, undesired pregnancy

Front 43

Older adults – physiological changes increase risk of falls & accidents ...examples

Back 43

MS - impair mobility

Neuro - slows reflexes/ reaction time

Sensory -  vision, hearing, touch

GU - nocturia, incontinence

Meds - side effects may also contribute to injury

Front 44

_________ - __________ Americans die each year from medical errors (8th leading cause of death)

Reasons for death.

Back 44

44,000 - 98,000

Med errors
Technical/Procedural errors
Diagnostic errors
Failure to prevent injury
Falls, pressure ulcers, infections, sepsis

Front 45

Risks in healthcare facilities...
Environmental risk examples

Back 45

Equipment or furniture inhibit ambulation
Call light, personal supplies out of reach
Equipment malfunction – iv pump
Chemicals – MSDS provide information about safe handling & emergency action if spills, contact occur. Know location.

Front 46

Name some risks in home.

Back 46

throw rugs
electrical equipment
obstructed pathways
lighting
need for safety equipment in bathroom
smoke detectors, etc.

Front 47

What should a nurse evaluate for safety in the home environment?

Back 47

Nurse should determine if patient can manage safely in the home prior to hospital discharge

Does patient have appropriate assistance in the home if needed? May need SNF

Can ask for Home Health to do home safety assessment

Front 48

FALL risks account for what % of reported incidents? And what else do falls account for?

Back 48

90

Increase length of hospital stay, risk of other complications
e.g. half of pts. w/ hip fx don’t return to previous level of functioning

Front 49

What factors increase the risk of client falls?

Back 49

Hx of falls, med side effects, need to use restroom, weakness due to dz, unsteady gait, osteoporosis, uncooperative pt, over age 65, pt forgets how to walk

Front 50

How can you reduce the risk of patient falls?

Back 50

Assess pt for fall risk, keep area free of clutter, bed alarms, call lights, NO skid shoes, toile schedule every 2 hrs, sitter, bedside commode, teach about call light

Front 51

RESTRAINTS - when should they be used?

Back 51

ONLY as a last resort to immobilize pt. or an extremity

Front 52

RESTRAINTS - May actually increase risk of injury. How?

Back 52

Whenever a client is restrained, there is a natural tendency for the client to try to remove the restraint. When this occurs, client injury is common. Restrained clients easily become entangled in a restraint device in attempts to get out of the device. In some cases, death has resulted because of strangulation or asphyxiation.
also associated with serious complications, including pressure ulcers, constipation, pneumonia, urinary and fecal incontinence, and urinary retention (see Chapter 47). Contractures, nerve damage, and circulatory impairment are also potential hazards. In addition, restrained clients experience a loss of self-esteem, humiliation, fear, and anger.

Front 53

RESTRAINTS - what alternative measures can be taken?

Back 53

Provide companionship and supervision; use trained sitters or adjust staffing. • Offer diversionary activities, such as music or something to hold; enlist support and input from the family. • Assign confused or disoriented clients to rooms near the nurses' station; observe these clients frequently. • Use calm, simple statements and physical cues as needed. • Use de-escalation, time-out, and other verbal intervention techniques when managing aggressive behaviors. • Provide appropriate visual and auditory stimuli (e.g., family pictures, clock, radio). • Remove cues that promote leaving (e.g., elevators, stairs, or street clothes). • Promote relaxation techniques and normal sleep patterns. • Institute exercise and ambulation schedules as allowed by the client's condition; consult physical therapist for mobility and exercise programs. • Attend to needs for toileting, food, and liquid. • Camouflage IV lines with clothing, stockinette, or Kling dressing. • Evaluate all medications client is receiving, and ensure effective pain management. • Reassess physical status, and review laboratory findings.

Front 54

RESTRAINTS - when do you use?

Back 54

Reduce the risk of client injury from falls.•Prevent interruption of therapy such as traction, IV infusions, nasogastric (NG) tube feeding, or Foley catheterization.•Prevent the confused or combative client from removing life support equipment.•Reduce the risk of injury to others by the client.

Front 55

Medicare /TJC - strict guidelines for use...examples and how often should they be checked?

Back 55

The use of a restraint must be clinically justified and be a part of the client's prescribed medical treatment and plan of care. A physician's order is required, based on a face-to-face assessment of the client. The order must state the type of restraint, location, and specific client behaviors for which restraints are to be used and must have a limited time frame. These orders need to be renewed within a specific time frame according to the agency's policy. Restraints are not to be ordered prn (as needed). Patient must be checked every hour and every 15 is necessary.

Front 56

Fire Safety - What is RACE and PASS?

Back 56

R – rescue clients in immediate danger
A – Activate alarm, report fire per policy
C- confine fire by closing doors & windows, shutting off O2
E – extinguish fire using correct extinguisher

P ull the pin
A im at base of fire
S queeze the trigger
S weep side to side

Front 57

What is a seizure and why does the client need to be protected?

Back 57

A seizure is usually a result of a neurologic injury or metabolic disturbance and involves a hyperexcitation of neurons in the brain leading to a sudden, violent, involuntary series of contractions of a group of muscles. The client often loses consciousness.

Front 58

What precautions should be taken if client is at risk for seizure?

Back 58

Seizure precautions encompass all nursing interventions to protect the client from traumatic injury, positioning for adequate ventilation and drainage of oral secretions, and providing privacy and support following the seizure

Front 59

Status epilepticus? – seizure lasting >15 min. or repeated seizures in a 30 min period.

Back 59

Seizure lasting >15 min. or repeated seizures in a 30 min period. a medical emergency whereby a person has continual seizures without interruption. An adequate airway is maintained with an oral airway. Never restrain clients experiencing a seizure. Instead, place them on seizure precautions and adequately protect them from traumatic injury.

Front 60

Before giving meds or food determine pt. ability to ?

Back 60

gag or cough if neurological system or level of conciousness (LOC) impaired. You can use a tongue depresser at back of tongue

Front 61

When giving intermittent enteral feedings or meds, always check placement first. How?

Back 61

30 ml of air...woosh
Aspirate residual

Front 62

What do you do in the event of bleeding?

Back 62

Apply direct pressure to wound with clean cloth or gauze. Avoid tourniquet.
When bleeding is controlled, clean wound with saline or commercial wound cleanser, apply dressing or arrange for further treatment e.g. sutures, cauterization

Front 63

Complete incident report for any event that causes or has potential to cause client / staff injury. Examples?

Back 63

Usually completed by person who discovers incident or per policy
Include only the facts of the incident, patient condition, care provided
Do not point fingers, make excuses, or rationalize

Front 64

Incident report - do you document that an incident report was done?

Back 64

no
Incident report is used for quality assurance purposes and is not admissible in court unless you mention it in the nurse’s notes

Front 65

Help client meet basic needs related to oxygen, nutrition, temperature, & humidity

Back 65

x

Front 66

Prevent falls or injury from restraints, siderails, equipment, fires

Back 66

x

Front 67

Assess risk for skin breakdown & follow recommended guidelines to reduce risk

Back 67

x

Front 68

Use 2 identifiers for client before each med or invasive procedure

Back 68

x

Front 69

Follow facility policies and procedures when performing procedures on clients

Back 69

x

Front 70

If a client has a visual impairment, what can you do to improve safety, reduce risk of injury?

Back 70

Guide them, put their glasses on…take the time to find the glasses.

Front 71

If a client has a hearing impairment, what can you do to improve safety, reduce risk of injury?

Back 71

If hearing aid…use it!! If no hearing aid…be in front of them talk lower,
Use hand signals, repeat…do not yell at them.

Front 72

What are sentinel events?

Back 72

occurrences that cause or have the potential to cause serious harm or death in a patient

Front 73

Client ID. Goal and Requirement.

Back 73

Goal: Improve the accuracy of client identification.
Requirement: Use at least two client identifiers (neither to be the client's room number) whenever administering medications or blood products; taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures.

Front 74

Improve communication...goal and requirement?

Back 74

Goal: Improve the effectiveness of communication among caregivers.

Requirement: For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the order or test result "read-back" the complete order or test result.

Requirement: Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization.

Requirement: Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.

Front 75

Medication safety...goal and requirement?

Back 75

Goal: Improve the safety of using medications.

Requirement: Standardize and limit the number of drug concentrations available in the organization.

Requirement: Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in the organization, and take action to prevent errors involving the interchange of these drugs.

Requirement: Label all medications, medication containers (e.g., syringes, medicine cups), or other solutions

Front 76

Health care Assoc. Infections...goal and requirements?

Back 76

Goal: Reduce the risk of health care-associated infections.

Requirement: Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines

Requirement: Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a healthcare-associated infection

Front 77

Reduce Falls...goal and requirements?

Back 77

Goal: Reduce the risk of client harm resulting from falls.

Requirement: Implement a fall reduction program and evaluate the effectiveness of the program

Front 78

Influenza and Pneumococcal....goal and requirements?

Back 78

Goal: Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.

Requirement: Develop and implement a protocol for administration and documentation of the flu vaccine

Requirement: Develop and implement a protocol for administration and documentation of the pneumococcus vaccine.

Front 79

Pressure Ulcers...goal and requirements?

Back 79

Goal: Prevent healthcare-associated pressure ulcers (decubitus ulcers).

Requirement: Assess and periodically reassess each resident’s risk for developing a pressure ulcer (decubitus ulcer) and take action to address any identified risks.