INFECTION CONTROL Flashcards
What is Hepatitis?
Inflammation of the liver caused by a virus.
How is Hep A Spred?
The fecal-oral route spreads Hepatitis A
How are Hep B/C spred?
Hepatitis B and Hepatitis C, are transmitted via bloodborne exposure.
In the dialysis setting, Hepatitis B and C are transmitted through either an exposure to the blood or body fluids of an infected person, through the mouth, eyes or nose (mucous membranes) or from an exposure to non-intact skin, or from a sharps injury.
How contagious is Hepatitis B or HBV?
Hepatitis B is considered to be very contagious because it can live in the environment and remain viable on surfaces for up to seven days.
The prevalence of HBV has decreased due to the availability and effectiveness of the HBV vaccination series.
Is Hepatitis C or HCV virus as contagious as Hepatitis B?
No it is not. It is not known to survive for very long outside of the body.
HCV is the most prevalent type of hepatitis that is found in the dialysis setting today.
There is currently no vaccine or an effective treatment available for people infected with Hepatitis C.
What precautions are required for hep c?
Standard (universal) precautions and wearing personal protective equipment (PPE) provides adequate protection against HCV.
What is Human Immunodeficiency Virus or HIV?
HIV is also a blood-borne pathogen.
What precautions are required for HIV?
Standard precautions and wearing personal protective equipment (PPE) provide adequate protection from HIV.
The HIV virus does not survive for very long outside of the body and is not easily transmitted; however, recent studies have shown that PD effluent may be a storehouse for HIV similar to HBV.
It has been documented that HIV can replicate and survive outside of the body for up to seven days.
How long is PD fluid contaminated with HIV considered infectious outside of the body?
Studies have concluded that HIV could be acquired and should be considered infectious for up to 48 hours.
What is Methicillin Resistant Stapholococcus Aureus or MRSA and Vancomycin Resistant Enterococci or VRE?
They are bacteria that are primarily spread through hand-to-hand contact by healthcare workers who come into contact with contaminated skin and/or
equipment.
How long can VRE live on surfaces?
VRE can live on surfaces for up to seven days.
How are MRSA/VRE spred even if the pt is not actively infected?
Even though a patient is no longer “actively infected”, MRSA and VRE may still be transmitted through hand-to-hand contact.
How long should healthcare workers use protective precautions for a pt that was previously infected with MRSA or VRE?
Protective precautions must be used until three negative cultures (one week apart) have been obtained
Do MRSA and VRE infected patients require isolation?
No
Although MRSA is not usually known to survive outside of the body or on inanimate surfaces for very long, a hemodialysis unit carries an increased risk of this occurring.
MRSA and VRE patients do not need isolation, but they should be seated together away from susceptible patients (cohorted) and should have their own designated blood pressure cuff, stethoscope, and tourniquet etc.
When should you use gloves when dealing with a patient infected with VRE or MRSA?
Gloves should be used for all patient and equipment contact.
Should you use a 1:10 bleach solution or a 1:100 bleach solution to cleanse the environment after a patient infected with MRSA or VRE was treated there?
All environmental surfaces touched by MRSA and VRE patients should be thoroughly cleansed with a 1:100 parts bleach solution.
What are Dialysis Unit Precautions?
Dialysis Precautions are stricter than “Standard or Universal Precautions”.
When working with MRSA, VRE or Hepatitis B patients, gowns, drape sheets, and catheter dressings should be disposed of into red infectious, biohazard
waste containers after each use.
How is Equipment disinfected to prevent blood borne pathogens?
All equipment used for HBV patients and environmental surfaces touched by HBV patients should be thoroughly cleansed with a 1:100 bleach solution also.
Which PPE should be used for HBV patients?
Gloves and a barrier gown should be worn for all contact with HBV patients and equipment.
Vaccination against HBV is highly recommended for all staff and patients.
What Personal Protective Equipment (PPE) is used at FMS?
Gloves, face shield or mask and goggles, along with a fluid impervious gown are worn as part of dialysis precautions.
Is wearing PPE optional?
Wearing PPE is not optional. It is mandatory.
Full PPE must be worn for IM, SC or IV injections, venipuncture or drawing labs and spinning blood, dressing changes, and disposing of or collecting sharps containers.
In addition, full PPE is needed for catheter irrigation, connection and disconnection procedures, emptying Peritoneal Dialysis (PD) effluent (fluid drained out), obtaining effluent or blood samples, and for exit site care.
What is to be done with PPE after use?
Remove all personal protective equipment immediately upon leaving the work area or as soon as possible.
Place PPE in an appropriately designated area or container for storage, washing, decontamination or dispose of in the proper waste receptacles.
What work place controls (x4) are there besides wearing PPE?
- Do not eat, drink, smoke, apply cosmetics or lip balm in work areas where there is a potential of occupational exposure.
- Do not store food and drink in refrigerators, freezers or cabinets where blood or other potentially infectious materials are stored.
- Supplies that are to be used for the next treatment must not be opened until just prior to use.
- When safe needle devices are in place, they are to be used in the manner that they were designed for, and sharps containers should never be more than ½ to ¾ full and should never be shaken down.
What is the most important infection control measure?
Hand washing is the most important infection control measure in preventing the transmission of infection.
How long should you wash your hands for standard patients?
As a general rule hands should be washed for at least 40-60 seconds.
How long should you wash your hands when working with MRSA, VRE or HBV patients?
When working with MRSA, VRE or HBV patients, hands should be washed for at least 60 seconds
How long should you wash your hands before providing a PD exchange?
When providing a PD exchange, transfer set, dressing change etc. it is required to wash hands for a minimum of 60 seconds
To perform a PD Exchange, how should hands be washed?
Before performing any PD exchanges, hands should be washed with liquid soap to prevent coming into contact with accumulated bacteria that may he present on bar soap.
Hands should be scrubbed thoroughly for one-minute by rubbing them together and applying friction to the entire surface of both hands, including fingertips and nails.
What is the recommended nail length and why?
Several controlled studies show that artificial nails harbor more bacteria than do natural nails.
The investigators suggest that long nails can facilitate colonization of bacteria on hands by making hand washing less effective and the use of gloves less practical.
Nail length has been linked to peritonitis in the PD patient population.
Determination of the root causes for peritonitis in your PD program should include an evaluation of nail length and type for both the nurses in the PD program, as well as the patients and/or caregivers.
FMC policy states natural fingernail length shall be kept to ¼ inch or less, and no artificial nails are permitted.
Is it necessary to constantly wash hands while wearing non-sterile gloves?
Yes, even with glove use, hand washing is needed because pathogens deposited on the outer surface of gloves can be detected on health care worker’s hands after glove removal, possibly because of holes or defects in the gloves, leakage at the wrist, or contamination of hands during glove removal.
What is the purpose of wearing gloves?
The purpose of wearing gloves is also to help prevent transmission of micro-organisms to the patients by acting as a protective barrier.
Gloves also protect the health care worker from acquiring blood borne diseases from the patient, but are not sufficient to use alone. Hand washing must accompany glove use.
Why must gloves be selected to fit hands well?
You will not be able to perform procedures well or be fully protected if the glove does not fit correctly.
Fresenius will provide you with a glove that fits you well and that your skin does not react to.
Gloves can never be reused.
When should gloves be worn?
When there is any potential for direct skin contact with blood, peritoneal fluid or other potentially infectious material, mucous membranes, and non-intact skin, and when handling items or surfaces soiled with potentially infectious materials.
Gloves should also be worn when administering IM or SC medications.
