Prevention and Control of Infectious and Communicable Diseases Flashcards
(152 cards)
1
Q
In the application of HACCP, is microbiological testing an effective means of monitoring CCPs?
A
no because of the time required to obtain results
2
Q
How are CCPs monitored?
A
through physical and chemical tests and visual observations
3
Q
Properly designed HACCP systems consider what hazards?
A
physical, chemical, and biological
4
Q
Define critical control point
A
a step at which a control can be applied and is essential to prevent or eliminate a food safety hazard or reduce it to an acceptable level
5
Q
define critical limit
A
a maximum or minimum value to which a parameter must be controlled at a CCP to reduce the hazard
6
Q
define HACCP
A
a systematic approach to the identification, evaluation, and control of food safety hazards
7
Q
What are the 7 HACCP principles?
A
- conduct a hazard analysis
- determine the CCPs
- establish critical limits
- establish monitoring procedures
- establish corrective actions
- establish verification procedures
- establish record keeping and documentation procedures
8
Q
Why are LTC residents at increased risk for gastroenteritis?
A
age-related decrease in gastric acid, proton pump inhibitors, and other anti acids
9
Q
What is the most common cause of gastroenteritis in the US?
A
Norovirus
10
Q
Which foods are commonly involved in foodborne norovirus outbreaks?
A
leafy greens, shellfish, fresh fruits
11
Q
Why is foodborne illness more serious for the elderly?
A
Risk of dehydration
12
Q
What are some steps to foodborne outbreak investigation?
A
- detect the outbreak
- define and find cases
- generate a hypothesis
- test the hypothesis
- determine source of contamination
- control the outbreak
- decide the outbreak is over
13
Q
Why is ab therapy for Salmonella only recommended for those with severe illness or at risk for complications?
A
it can prolong the duration of excretion of non-typhoidal salmonella
14
Q
True or false. Antibiotic resistance for Salmonella is increasing?
A
True
15
Q
which rugs are used to treat salmonella?
A
ampicillin, fluroquinolones, third generation cephlasporins
16
Q
Which animals are likely to harbor Salmonella?
A
reptiles and young birds
17
Q
what is clostridium perfringens?
A
a spore-forming, gram positive bacterium that may produce toxins causing disease in the intestines
18
Q
where is C. perfringens found?
A
the digestive tracts or humans and animals and environmental sources
19
Q
Which foodborne illness develop with 6-24 hours and last less than 24 hours?
A
C. perfringens
20
Q
People with ____ typically do not have fever or vomiting
A
C. perfringens
21
Q
Which foodborne illness is NOT transmitted from one person to another?
A
C. perfringens
22
Q
What are sources of C. perfringens infection?
A
beef, poultry, gravies, and dried or precooked foods. Often occurs when foods are prepared in large quantities and kept warm for a while before serving
23
Q
Foods should be kept warmer than ____ or cooler than ___ to prevent growth of C. preferingens that survived the initial cooking process
A
140F (60C) or 41F (5C)
24
Q
leftover foods should be stored at what temp?
A
40F (4C)
25
Which food borne illness may cause bloody diarrhea?
campylobacter
26
A resident with listeriosis would usually have what symptoms?
fever and muscle aches, sometimes preceded by diarrhea or GI
27
True or false. Most people with listeriosis usually do not have an invasive infection (meaning bacteria spread beyond the GI tract)
False
28
What are common invasive presentations of listeriosis?
meningitis and septecemia
29
True or false. Hand rub is accptable in food prep areas
False. Use hand washing
30
True or false. Ready to eat foods can be handled with bare hands
False
31
Who provides regulations for linen management?
CMS
32
What are some general inspection critieria for laundry?
-a physical barrier between clean and soiled linen areas
-to avoid re-contamination of clean linen, ventilation should not move from soiled processing areas to clean laundry areas
-clean and disinfectant carts, shelves, and folding tables
-procedure for handling sharps found in linen
-hand hygiene products and washing sinks available to laundry personnel
-train personnel on PPE
-procedure for cleaning utility gloves between use
-laundry equipment is checked and maintained and this information documented
33
Is chlorine bleach required for all laundry?
No
34
do laundry detergents have to state they are antimicrobial?
No
35
Is ozonated water acceptable for laundry processing?
Yes
36
What is the cleaning process for linen with lice or scabies?
Wash and dry at high temps. Treating with an insecticide is not necessary
37
What are infection measures for gait belts?
have one dedicated to the resident and clean between resident uses
38
What info should the IP know about the lab?
-types of tests and normal ranges for each
-turnaround times
-holding and transport
-specimen collection procedures
-methods of reporting results
-tests not performed
39
How should urine for culture be obtained?
freshly voided or from the catheter/ not from the drainage bag
40
residents with indwelling urinary catheter should have the device changed before collection if it has been in place for longer than how long?
14 days
41
True or false. You should assign multidose vials to a single resident where possible
True
42
True or false. You should disinfect vial hubs prior to use
true
43
True or false. Footcare is outside of the life enrichment scope and should only be performed by authorized individuals
True
44
True or false. designated nail care tools are ideal
True
45
Should transport vehicle drivers have bloodborne pathogen training and hep B vaccination?
Yes
46
True or false. Dogs should be discouraged from licking and patients should not give treats to dogs
True
47
Which animals should not be LTC pets?
stray, wild, or feral animals. Reptiles, snakes, amphibians, and turtles. Monkeys and nonhuman primates, guinea pigs, rats, chinchillas, mice, hedhehogs, ferrets, sugar gliders
48
Which residents should be vaccinated against hepatitis b?
those who have diabetes, kidney or liver disease
49
CMS requires which vaccines be oferred to new admissions?
Influenza and pneumococcal
50
Pneumonococcal vaccination is recommended as
a series of two different vaccines (PCV13 and PPSV23)
51
What are recommended vaccines fr LTC residents?
-influenza
-td
-tdap
-shingles
-pneumococcal
-hep B (select residents)
52
what time of year is Influenza vaccine recommended?
September to May
53
Which vaccine info is required to be recorded?
-edition date of the VIS
-date VIS provided
-name, address, and title of the person who gave the vaccine
-date of administration
-vaccine manufacturer and LOT
-consent obtained
-type and name of vaccine
-LTC facilitys address
54
Is there a federal requirement for informed or written consent prior to vaccination?
No
55
do influenza and pneumovax require a written physician order?
No
56
do some states have informed consent laws?
Yes
57
Depending on which vaccine is given, adverse events have to be reported. The VAERS requires what information?
-type of vax
-timing of vax
-onset of adverse event
-current illnesses or medication
-past history of adverse events following vaccination
58
Refigerated vaccines must be stored at what temp?
36F-46F
59
True or false. Blood glucose monitors can spread hep B between patients because Hep B is environmentally stable and blood that can't be seen with the naked eye can transmit
True
60
Which flu vaccines can be given to adults 65+?
standard or high dose, trivalent or quadrivalent, unadjuvanted or adjuvanted
61
Medicare pays for what vaccines?
influenza, hep b if you're at intermediate to high risk, and pneumonococcal
62
What temp should whole meats be cooked to?
145F
63
What temp should ground meats be cooked to?
160F
64
What temp should poultry be cooked to?
165F
65
What are the effects of botulism on the body?
stops the bodys control of muscle movement including the muscles that help you breathe
66
True or false. Botulism creates toxic spores
True
67
What are the 3 types of botulism?
1. foodborne botulism
2. infant botulism
3. wound botulism
68
Where does botulism typically come from?
improperly home-canned, preserved, or fermented foods
69
What are some foods that have caused Salmonella?
Eggs, cucumbers, chicken, raw tuna, sprouts, pre-cut melon
70
What are some foods people who are more likely to get food poisoning should not eat?
-undercooked or raw animal foods
-raw or lightly cooked sprouts
-unpasteurized milk or juices
-soft cheeses unless made with pasteurized milk
71
What are 5 signs of severe food poisoning?
1. fever 103F
2. bloody diarrhea
3. vomitting so hard you can't keep liquids down
4. diarrhea lasting more than 3 days
5. signs of dehydration
72
What are some germs commonly found in meat?
salmonella, e.coli, yersinia
73
what are some germs commonly found in poultry?
salmonella, campylobacter, c. perfringens
74
Which bacteria can raw milk carry?
salmonella, campylobacter, cryptosporidium, e.coli, listeria, and brucella
75
Which germs can raw seafood contain?
vibrio and norovirus
76
Fish with fins should be cooked to what temp?
145F
77
Which germs can you get from raw flour?
salmonella and e. coli
78
How long does a refigerator keep food safe during a power outage if you don't open the door?
4 hours
79
True or false. A full freezer will keep food safe for 48 hours (or 24 if half full) without power if you don't open the door
True
80
_____ alcohol has a slightly greater activity against bacteria and ____ alcohol has a greater activity against viruses
isopropyl; ethyl
81
ABHR must contain what range of ethyl or isoproperyl alcohol?
60-95%
82
What are some methods for monitoring hand hygiene adherence?
1. directly observe HH opportunities and adherence
2. monitor the volume of HH products used per 1000 patient days
3. video monitoring or sensing devices
83
What are 5 fundemental elements needed to prevent the transmission of infectious agents?
-internal communiction
-extneral communication'-administrative support
-adequate IPAC staffing
-education
84
How many air exchanges per hour are needed in an airborne isolation room?
6-12 exhausted outside
85
True or false. A patient on airborne precautions must wear an N95 to leave their room
False. They need to wear only a surgical mask.
86
What is a protective environment?
it is recommended for allogenic hematopoietic stem cell transplant recipients to reduce the risk of invasvie envrionmental fungal infections and other opportunistic infections.
87
what environmental controls are used to create a protective environment?
filter incoming air with HEPA filtration that is at positive pressure with relation to the corridor at 12 air exchanges per hour.
88
what environmetnal measures are used for a protective environment?
-clean rooms with techniques that minimize dust
-avoid upholstered furnishings
-wet dust horizontal surfaces
-prohit dried and fresh flowers or potted plants
89
How do you implement airborne precautions in the protected environment?
-anteroom must be present
-hepa filter in the anterroom
-positive air pressure
90
Asepsis is defined as
the process of preventing contact with microbes
91
True or false. Alcohol has no residual antimicrobial effect but immediately lowers bacterial counts
True
92
True or false. CHG has residual effects and is approved for hand asepsis
True
93
What are antiseptic agents?
antimicrobial substances applied to the skin to reduce microbial flora
94
True or false. OSHA requires employers provide appropriate PPE to workers who could be exposed to blood and infectious materials
True
95
Which sections of OSHA make employers responsible for ensuring that required PPE is worn by the worker?
25 and 27
96
Under what section of the OHSA do workers have a duty to wear or use the PPE required by law and the employer?
Section 28
97
True or false. Workers must report any missing or defective PPE to the supervisor
True
98
When is hand hygiene with soap and water recommended?
-when hands are visibly soiled
-when preparing food
-contact with c.diff or Norovirus
99
why is ABHR the gold standard for HH?
-rapid antimicrobial effect
-reduce dryer of users skin
-more convineint
-leave minimal to no residue
-do not contribute to antibiotic resistance
100
selection of hand hygiene products should be based on what?
-cost effectiveness
-smell
-conistency/feel of product
-color
-ease of lathering
101
what should some components of a PPE training program be?
-when PPE is worn
-what PPE to wear
-how to don, remove, adjust, and wear each type of PPE
-care, maintenance, useful life, and storage of PPE
=how and when PPE should be safely disposed of
-limitations of each type of PPE
-competency reassessment (no less than annually)
102
what are the 3 primary reasons for using PPE in LTC?
1. resident care
2. cleaning and disinfecting the facility (especially resident rooms)
3. cleaning and disinfecting reusable equipment, devices, and the environment
103
what are 2 OSHA PPE regulations?
1. BBP standard
2. respiratory protection standard
104
what is outlined in the BBP standard?
-masks, eye protection, face shields, and gowns are mandated to be worn at no cost to the employee when there is a risk of the employee to blood
-maintain appropriate PPE, reappraisal of PPE stock, selection, and provision
105
when does NIOSH require an N95 be worn?
for airborne precautions or seasonal influenza if an aerosol-generating procedure
106
what is the donning sequence?
gown
mask
shield or googles
gloves
107
what is the doffing sequence?
gloves
sani
goggles or shield
gown
sani
mask
wash hands or use ABHR after removing all PPE
108
Where do you dipose of PPE?
before leaving the patients room
109
where do you dispose of an N95?
after leaving the room
110
what are 3 factors for evaluating PPE?
-availability and accessibility
-storage
-correct usage
111
if re-capping a needle is necessary what technique should be used?
one-handed
112
safety devices of needles must be engaged ____ after use
immediately
113
part of respiratory etiquette means wear a mask if unable to maintain spatial separation ___ feet between beds
3
114
what are standard precautions for resuscitation?
use motuhpiece, resuscitation bag, or ventilation devices to prevent contact with mouth and oral secretions
115
what are some factors to consider when implementing TBP?
-administrative support
-infection prevention staffing
-communication
-policies and procedures
-education
-infrastructure
116
what is the hierarchy of controls for TBP?
1. PPE
2. Administrative controls
3. engineering controls
4. substitution
5. elimination
117
what are some components of droplet precautions?
-3 to 6 feet distance of transmission
-masks and eye protection for staff
-residents wear a surgical mask
118
what PPE has to be worn on airborne precautions?
-massks and N95 (addition of gloves and gown based on PCRA)
-washout period
-resident wears a surgical mask when mobilizing
119
what are some high contact situations for EBP?
-bathing/showering
-bathroom assistance
-dressing/changing clothes
-wound or device care
-changing linens
120
what are intensified precautions?
Used when both SP and TBP fail to halt transmission of infectious organisms
121
what are examples of when to implement intensified precautions?
-cohorting infected and colonized residents
-dedicating staff to care for isolated or cohorted residents
-restricting new admission or closing affected nursing units
-increasing and enhancing environmental cleaning and disinfection procedures
-performing active surveillance cultures
122
foods purchased and prepared must meet ___ requirements
FDA
123
frozen foods should be kept at what temps?
-10 to 0F
124
eggs should be stored at what temp?
45F or 40F for best quality
125
dairy products, meat, poultry, and shellfish should be stored at what temp?
32 to 41F
126
dry storage should be what temp?
50 to 70F
127
fruits and vegetables should be stored at what temp?
32 to 41F
128
what are the steps to a foodborne outbreak control investigation?
1. detecting
2. defining case and notifying the health department
3. hypothesis generation
4. testing the hypothesis
5. find the point of contamination
6. control the OB
7. declare over
129
which FBI lasts less than 24 hours and is not passed person to person?
clostridium perfringens
130
which FBI is a risk to LTC residents participating in pet therapy>
salmonella
131
almost everyone diagnosed with this FBI has an inasvive infection that spreads beyond the GI tract and common presentations are meningitis and septicemia
listeria
132
this foodborne illness has a seasonal infection risk
cyclospora (a parasite found in tropical and subtropical regions)
133
cyclospora is linked to what foods?
imported fresh produce, raspberries, basil, snow peas, cilantro (not frozen or canned produce)
134
what is onychomycosis?
dust control measure, proper PPE and cleaning and disinfectant after podiatric treatment
135
what are some IPAC practices for podiatric care?
-sterilie/disifnect equipment using HLD
-diabetic foot ulcers are treatment in outpatient poditary
-mechanism of reporting for residents with infection post procedure
-dedicated treatment spaces
-checklist and observation tool to measure adherence to IPC policies
136
what are IPAC rules for cosmetic nail and hair care?
-disposable product, cleaning guidelines, chemical use and storage, salon safety rules
-EPA approved disinfectant
-personnel to only perform services within scope
-proper PPE when nail care is done
137
what are some risks for residents and dental HPC?
blood and oral/respiratory excretions, improper reprocessing, poor water quality, sharps
138
what are some IPAC dental care policies?
-regulation requires assessment of oral health of residents on admission then on regular schedule (quarterly/annually) through outside services
-toothbrush replaced every 3 months. Use antimicrobial alcohol rinse to clean brushes
139
what are routes of transmission for dental care?
-direct contact
-indirect contact
-aerosols
140
Which agency regulates antiseptic agents?
FDA
141
alcohols concetration of ABHR should be
60-95%
142
what are examples of when soap and water should be used
-after caring for a patient with GI or a spore forming organism
-after using the restroom
-before eating or preparing food
143
what area of the hands harbors high bacteria concentrations?
subungual
144
large droplets travel ____feet whereas small droplets travel ____ feet
1-3; 3-6
145
where does air from an AIIR get exhausted?
outside
146
do transport staff of a patient on airborne precautions need to wear respiratory protection?
no if the patient is masked and all skin lesions are covered
147
when should a patient wear an N95?
patients leaving a protected environment during times of construction
148
what do you do if a patient in a protective environment needs to be on airborne precautions and an anteroom is not available?
place in an airborne room and use a HEPA filer inside to filter fungal sproes
149
which product has persistent effects and is approved for hand antisepsis?
CHG
150
what are some elements of a respiratory hygiene program?
-education
-signs
-controls
-hand hygeine locations
151
what is antimicrobial soap?
soap that contains an antiseptic agent
152
What is a control point?
any step at which biological, physical, or chemical factors can be controlled
