During a procedure in ICU, blood spills onto the outer plastic casing of an in-use ventilator. After cleaning the surface using gloves and disposable gauze pads, how would you decontaminate it?
- spray the area with a concentrated isopropyl alcohol solution
- swab the area with a tuberculocidal disinfectant or bleach solution
- take the ventilator out of service and have it sterilized
- wash the surface with a detergent and rinse with sterile water
Should a spill of blood or body fluids occur, you should first use don gloves and other protective equipment and clean area with disposable absorbent material, which should be discarded as infectious waste. You should then swab the area with a cloth or paper towels wetted with an EPA-registered hospital disinfectant labeled tuberculocidal solution. Alternatively, you can use either a registered germicide that is active against HIV or hepatitis B or a 1:100 bleach (sodium hypochlorite) solution. More concentrated bleach solutions (1:10) should be used for spills involves large amounts of blood or body fluids. Bleach should not be used as a disinfectant on metallic surfaces (especially aluminum) because it can be corrosive to these materials.
A patient who was hospitalized with ARDS recently traveled to an area with a documented outbreak of a severe atypical respiratory infection of unknown origin. Which of the following infection control precautions should you recommend for this patient?
- Airborne precautions: Yes; Contact precautions: Yes; Droplet precautions: No
- Airborne precautions: Yes; Contact precautions: Yes; Droplet precautions: Yes
- Airborne precautions: Yes; Contact precautions: No; Droplet precautions: Yes
- Airborne precautions: No; Contact precautions: Yes; Droplet precautions: Yes
If either the suspicion of SARS is strong or laboratory evidence confirms a SARS-CoV infection, the CDC recommends a combination of standard, contact, and strict airborne precautions to manage these patients.
In addition to standard precautions, which of the following transmission-based precautions would you recommend for an elderly patient admitted to a medical unit with severe viral influenza?
- contact precautions
- droplet precautions
- airborne precautions
- universal precautions
Influenza is one of several common infections spread by the transmission of large droplets (greater than 5µm) in the air. Droplet precautions are designed to thwart this route of transmission and include (1) placing the patient in a private room; (2) wearing a surgical mask when within 3 feet of the patient; (3) using eye/face protection if aerosol-generating procedure performed or contact with respiratory secretions anticipated; and (4) having the patient wear a mask and follow respiratory hygiene/cough etiquette when being transported outside their rooms.
You need to transport several contaminated nondisposable ventilator circuits from a patient unit to an equipment processing area. You would:
- wash and disinfect the circuits at point of origin before transporting
- bag the circuits, then transport on a cleaned and sanitized cart
- transport the circuits in leak- and puncture-resistant biohazard bags
- place circuits in biohazard bags, then transport in a closed, rigid container
To transport infectious waste within the hospital, you should first place it in a leak- and puncture-resistant biohazard bag, then place the bag in a rigid and puncture-resistant biohazard container. Containers should be covered with lids and transported on carts. Plastic bags alone should not be used as primary containers for transportation of infectious waste.
Which of the following chemical disinfectants would you choose if the objective were to kill both the vegetative and spore forms of bacterial pathogens?
- a glutaraldehyde solution
- a 70% ethyl alcohol solution
- a quaternary ammonium solution
- an iodophor solution
Alcohols, phenols, quaternary ammonium compounds ("quats") and iodophors are generally ineffective against bacterial spores. Immersion in a glutaraldehyde (e.g., Cidex) can achieve full sterilization (sporicdal action), but can require up to 10 hours. Shorter periods provide only high-level disinfection.
Instructions for an electrically-powered respirometer clearly specify that it cannot be immersed in water. What procedure would you recommend to decontaminate this device before further processing?
- a quick wash in a flurocarbon-based liquid
- microwave heating at low energy for 3 minutes
- surface disinfection with 70% alcohol
- immersion in 2% glutaraldehyde for 10 minutes
Decontamination procedures remove infectious materials, particularly organic residues, from equipment that has been in-use. Normally, this is accomplished by complete disassembly and washing in a disinfectant detergent. Objects that cannot be immersed, such as certain electrical equipment, should at least be surfaced disinfected with a 70% alcohol solution or the equivalent.
Which of the following disinfectants would you select to clean up a blood spill?
- ethyl alcohol
- sodium hypochlorite
For blood spills, the CDC recommends either a EPA-registered germicide or sodium hypochlorite (1 part household bleach to 10 parts water). Because it is corrosive to metals (especially aluminum), bleach should not be used to decontaminate medical instruments with metallic parts.
What is the primary purpose of using chemical indicators in equipment sterilization processing?
- to warn the user about the presence of toxic residues
- to show that a package has been through a sterilizing process
- to indicate the remaining safe shelf-life of the equipment
- to verify that the sterilization process has worked
Chemical indicators are usually impregnated on packaging tape. These indicators change color when exposed to specific conditions, telling the user that the package has been processed via an appropriate sterilizer cycle. Chemical indicators cannot assure that the contents are actually sterile. Only biological indicators can provide that information.
To assist in preventing ventilator-acquired pneumonia (VAP), you should:
- use the minimal leak technique to inflate tracheal tube cuffs
- change the ventilator circuit and humidifier every 24 to 48 hours
- maintain the patient in the prone position whenever possible
- implement daily sedation vacations/spontaneous breathing trials
To help prevent VAP, avoid intubation when possible (using NPPV instead); if necessary, use the oral route and insert a tube that can aspirate subglottic secretions. In addition, elevate the patient’s head at least 30 degrees and implement daily and spontaneous breathing trials without sedation. For intubated patients, be sure to maintain a leak-free cuff seal (avoid the minimal leak technique!). Last, only change ventilator circuits when visibly soiled or malfunctioning.
Good practice in using bags to handle infectious waste include all of the following except:
- select tear/puncture-resistant bags coded for biohazardous waste
- load sharps in the bag after other contaminated equipment
- do not load a bag beyond its weight or volume capacity
- keep bags from coming into contact with sharp external objects
Good practice in using bags to handle infectious waste include the following: select tear/puncture-resistant bags coded for biohazardous waste; do NOT place sharps, sharp items, or items with sharp corners in bags; do not load a bag beyond its weight or volume capacity; keep bags from coming into contact with sharp external objects. For extra protection, one can also consider double bagging.
Which of the following is the most important way to help prevent transmission of infections in the hospital?
- instituting strict isolation procedures
- thoroughly cleaning respiratory therapy equipment
- using proper hand decontamination/hygiene techniques
- taking special precautions when handling contaminated equipment
Given that most hospital-acquired infections occur due to contact between patients and health care workers, good hand hygiene is the most important way to help prevent transmission of infections in the hospital. Hand hygiene should be performed before and after each patient contact; immediately after removing gloves; and after touching blood, body fluids, secretions, excretions, or contaminated items.
When administering a drug aerosol treatment to a patient under Contact Precautions due to an enteric bacterial infection, which of the following should be worn?
2. sterile gloves
3. sterile gown
- 1, 2 and 3 only
- 2 and 4 only
- 2 and 3 only
- 1, 2, 3 and 4
Contact precautions help reduce the risk of transmission of microorganisms by direct or indirect contact. Contact precautions call for the patient to be placed in a private room and for health care professionals and visitors who enter to wear a clean gown and gloves.
Airway management techniques that can help decrease the incidence of ventilator-acquired pneumonia (VAP) include all of the following except:
- using the nasal route instead of the oral route for intubation
- using an ET tube that can aspirate subglottic secretions
- maintaining proper endotracheal tube cuff pressures
- using only sterile fluids to flush suction catheters
Airway management techniques that can help decrease the incidence of VAP include: (1) avoiding intubation when possible (using noninvasive ventilation instead); (2) intubating via the oral (as opposed to nasal) route; (3) maintaining proper ET tube cuff pressures; (4) aspirating subglottic secretions; and (5) using only sterile water or saline to flush suction catheters. Ventilator circuits should be changed only when visibly soiled or malfunctioning.
In preparing for a bronchoscopy on a patient suspected of having an atypical viral infection causing severe respiratory distress, which of the following equipment would provide INADEQUATE protection?
- eye shield
- disposable gloves
- disposable gown
- surgical mask
During aerosol-generating procedures on patients suspected of having an atypical influenza-like infection transmitted by respiratory aerosols (e.g., SARS), you should don gloves, a gown, and face/eye protection. Because a standard surgical mask provides inadequate protection, you should wear a fit-tested N95 respirator. For the highest level of protection consider a surgical hood with an N-95 respirator or use a powered air-purifying respirator (PAPR).