Infection, prevention and control 1&2

Question 1

Micro-organisms

Answer 1

Micro-organisms (bacteria and viruses) live in or on some parts of the body e.g skin, mouth, bowel- are known as the body’s normal or ‘resident’ flora.

Question 2

Transient micro-organisms

Answer 2

On surface of skin, things we touch- easily transferrable, acquired or deposited on the skin by other people or from the environment and are known as ‘transient’. These do not live permanently on the skin and can be readily removed or destroyed by thorough and frequent hand hygiene.

Question 3

Resident micro-organisms

Answer 3

Found in the first layer of skin, nasal passages, etc.

Question 4

SICPs (Standard Infection Control Precautions)

Answer 4

Designed to prevent cross contamination from recognised and unrecognised sources of infection. They should be applied at all times within a healthcare setting or when healthcare is being provided and must underpin all activities.

Question 5

Key areas covered by the precautions

Answer 5

• Hand hygiene and washing
• Bodily fluid spillages
• Safe disposal of sharps
• Decontamination of equipment
• Handling of bed linen
• Personal protective equipment

Question 6

Anti-bacterial hand rub

Answer 6

Antibacterial or alcohol hand rub can be used between caring for different people and between care activities for the same person. However, remember that alcohol hand rub fixes dirt the skin (trapping it underneath) so your hands have to be visibly clean.

Question 7

Soap and water

Answer 7

Hands must be washed with soap and water if clostridium difficile or norovirus is suspected or if there is an outbreak of diarrhoea and vomiting, alcohol hand rubs are ineffective in such situations.

Question 8

Key moments to wash hands

Answer 8

• Before touching a patient
• Before a procedure
• After a procedure
• After touching a patient
• After touching a patient’s surroundings

Question 9

How long should you perform the eight stage technique for when using alcohol hand rub?

Answer 9

20-30 seconds. If hand rub becomes dry before 20-30 seconds, apply more.

Question 10

How long should you perform the eight stage technique for when using soap and water?

Answer 10

30-40 seconds

Question 11

Eight stage hand washing technique

Answer 11

• Wet hands with water
• Apply soap
• Rub palms
• Right hand over left dorsum with interlaced finger- vice versa
• Palm to palm with fingers interlaced
• Backs of fingers to opposing palms with fingers interlocked
• Rotational thumb rubbing
• Finger tips on palm
• Rinse hands

Question 12

What is the purpose of hand hygiene?

Answer 12

To reduce healthcare associated infections (HCAI)

Question 13

Choices of hand agents

Answer 13

• Alcohol-based rub
• Soap and water
• Antiseptic solutions

Question 14

Why would you use alcohol-based rub?

Answer 14

• To remove transient micro-organisms
• Quick and easy to use
• Better tolerated by the hands
• Effective

Question 15

When would you NOT use alcohol-based rub?

Answer 15

• When hands are visibly soiled

- When caring for a patient with vomiting or diarrhoea - whether gloves have been used or not

Question 16

Why would you use soap and water?

Answer 16

• To remove dirty, organic matter or transient micro-organisms
• When hands are visibly soiled with bodily fluids
• When caring for a patient with vomiting or diarrhoea
• When caring for a patient with diagnosed norovirus or clostridium difficile
• After several consecutive applications of alcohol-based hand rub

Question 17

When would you use antiseptic solutions?

Answer 17

• When required to reduce transient and resident micro-organisms
• Seeking a residual effect
• Before surgery and other invasive procedures
• In other circumstances such as during an outbreak of infection or as advises by the hospitals infection control team

Question 18

What are the five moments for hand hygiene?

Answer 18

1) Immediately BEFORE each episode of direct patient contact or care, including clean aseptic hygiene
2) Immediately AFTER each episode of direct patient contact or care
3) Immediately AFTER contact with bodily fluids, mucous membranes and non-intact skin
4) Immediately AFTER other activities or contact with objects and equipment in the immediate patient environment that may result in the hands being contaminated
5) Immediately AFTER the removal of gloves

Question 19

How can you ensure your hands are ready to be decontaminated?

Answer 19

• Remove all wrist and hand jewellery
• Wear short sleeved clothing when delivering patient care
• Making sure fingernails are short, clean and free from false nails and nail polish
• Covering cuts and abrasions with waterproof dressings

Question 20

What are the 3 Stages of effective hand washing?

Answer 20

1) Preparation
2) Washing
3) Drying

Question 21

What are the risks/hazards of hand hygiene products?

Answer 21

• Skin irritation
• Accidential eye splashes
• Ingestion
• Fire hazard

Question 22

What would you do in the event of a urine spillage?

Answer 22

• Clean the area with a general purpose detergent

- Dry the area thoroughly

Question 23

What would you do in the event of a vomit spillage?

Answer 23

• Wipe up the area with disposable paper towels
• Clean the area using a detergent
• Dry the area thoroughly

Question 24

What would you do in the event of a blood spillage?

Answer 24

• Cover the area with paper towels
• Allow the towels to soak up the blood before disposing
• Clean the area using a bleach solution
• Dry the area thoroughly

Question 25

What would you do in the event of a splash in the eye or mouth?

Answer 25

• Stop what you are doing
• Wash out your eyes or mouth with cold water
• Inform your manager, contact occupational health or A&E out of hours
• Complete an incident report

Question 26

What would you do in the event of a splash on broken skin?

Answer 26

• Stop what you are doing
• Wash the area under running water
• Dry the area and apply a waterproof plaster
• Inform your manager, contact occupational health or A&E out of hours
• Complete an incident report

Question 27

What would you do in the event of a sharps injury?

Answer 27

• Stop what you are doing
• Dispose of any contaminated sharps appropriately
• Encourage the wound to bleed with gentle pressure (do not suck the wound)
• Dry the wound and apply a waterproof plaster
• Inform your manager, contact occupational health or A&E out of hours
• Complete an incident report

Question 28

How do you handle bed linen?

Answer 28

• Staff must wear personal protective equipment when handling dirty linen and ensure that their hands are decontaminated prior to handling clean linen
• Infected and heavily soiled linen should be handled carefully in line with local standard operating procedure
• If the patient is at home, any linen should be washed at a temperature of at least 60 degrees
• Staff must wear personal protective equipment when handling dirt linen

Question 29

How to use PPE

Answer 29

• An apron and gloves must be worn when there is a risk of exposure to blood and body fluids and for close patient contact, even bed making
• The gloves should be applied after the apron but removed before the apron (gloves last on but first off). Both must be single use only and should be discarded after each care activity and before contact with other items e.g door handles, pens, etc.
• Your hands must still be cleansed once the gloves have been removed

Question 30

What patients are at risk?

Answer 30

• People with dementia
• People of an advanced age
• People with immunological issues
• People underlying chronic diseases e.g diabetes, chest, heart disease, cancer
• People with other existing infections
• People taking drugs e.g steroids, chemotherapy drugs
• People with indwelling medical devices e.g urinary catheters

Question 31

What is unacceptable practice?

Answer 31

• It is never acceptable to wash gloves rather than change them- single use only
• Touching your pen, a door handle or curtains after care activity before gloves are removed and hands decontaminated is also unacceptable practice
• It is not acceptable to wear the same pair of gloves or apron between patient activity or to not wash yours hands

Question 32

What is a duty of care?

Answer 32

Duty of care means to ‘cause no harm’ and is imposed through law upon every care worker in the country to stop them being reckless or negligent

Question 33

What are the six parts of the chain of infection?

Answer 33

• Infectious agent
• Reservoirs
• Portal of exit
• Means of transmission
• Portal of entry
• Susceptible host

Question 34

What is the infectious agent?

Answer 34

Any micro-organism that can produce infection e.g a pathogenic microorganism, e.g. MRSA, Clostridium difficile.

Question 35

What is the reservoirs?

Answer 35

The place an organism resides e.g water, food, respiratory tract, bowels, etc.

Question 36

What is the portal of exit?

Answer 36

Needs to leave the reservoir to establish infection i.e mouth, open wound, rectum through faeces, urine, vomit, skin cells, respiratory tract secretions, etc.

Question 37

What is the means of transmission?

Answer 37

How out travels, direct or indirect, from inanimate objects of living organisms.

Question 38

What is the portal of entry?

Answer 38

The place it enters the body e.g wound, broken skin, respiratory, gastrointestinal or genito-urinary tract.

Question 39

What is the susceptible host?

Answer 39

A person who is at higher risk of infection e.g immunosuppressed individuals, elderly, newborns, terminally ill individuals, etc.

Question 40

Decontamination: What is sterilisation?

Answer 40

Suitable where there is contact with breaks in the skin/mucous membranes, or for equipment introduced into sterile body areas.

Question 41

Decontamination: What is cleaning?

Answer 41

Suitable for equipment not in contact with the patient, or in contact with healthy skin.

Question 42

Decontamination: What is disinfection?

Answer 42

Suitable where there is contact with mucous membranes, or where there is a risk of contamination by transmissible micro-organisms.

Question 43

What is a killed vaccination?

Answer 43

Contain killed, but previously virulent, micro-organisms that have been destroyed with chemicals, heat, radioactivity or antibiotics, e.g Influenza, cholera, bubonic plague, polio, hep A, rabies.

Question 44

What is an attenuated vaccination?

Answer 44

Contain live, attenuated microorganisms. Many of these are live viruses that have been cultivated under conditions that disable their virulent properties, or which use closely related but less dangerous organisms to produce a broad immune response. Although most attenuated vaccines are viral, some are bacterial in nature, e.g Viral Diseases(yellow fever, measles, rubella, and mumps) Bacterial Diseases (typhoid, BCG).

Question 45

What is a toxoid vaccination?

Answer 45

Made from inactivated toxic compounds that cause illness, rather than from the micro-organism. Toxoid vaccines are known for being effective, e.g Tetanus, diphtheria.

Question 46

What is a protein subunit vaccination?

Answer 46

Microorganism fragment combined with other organic material and used to create an immune response, e.g Hep B, human papillomavirus (HPV).