Week 1 - infection control and patient assessment

Question 1

Medical asepsis vs surgical asepsis

Answer 1

Medical asepsis = “clean technique” = procedures can limit or even prevent the transmission of microorganisms that can spread disease
* Involves hand washing, using PPE, reporting exposures, cleaning/disinfecting/sanitizing (NOT sterilizing)

Surgical asepsis = “sterile technique” = procedures that kill or eliminate microorganisms

Question 2

Nosocomial infection

Answer 2

Nosocomial
= HAI = Hospital Acquired Infection

Question 3

What are the most common types of HAIs in Canada (5)?

Answer 3

1. MRSA = Methicillin Resistant Staphylococcus Aureus
2. VRE = vancomycin-resistant Enterococci
3. CDI/C. Diff = clostridioides difficile
4. COVID-19
5. Norovirus

Question 4

MRSA

Answer 4

MRSA = Methicillin Resistant Staphylococcus Aureus

colonizes healthy ppl, non-specific (lungs, heart, bone…), spreads through direct and indirect contact)

Question 5

VRE

Answer 5

VRE = vancomycin-resistant Enterococci

prefers weakened host, resides in intestinal/urinary tract, spread through contact

Question 6

CDI / C. Diff

Answer 6

CDI/C. Diff = clostridioides difficile

resides in bowel, common cause of infectious diarrhea in healthcare setting, antibiotics don’t work, spreads through direct/indirect contact (really gets around)

Question 7

COVID - 19

Answer 7

respiratory tract, spreads through droplets

Question 8

Norovirus

Answer 8

GI tract, just a few particles can make you ill, spreads through direct/indirect contact

Question 9

TIER 1: Std/Routine practices

vs
TIER 2: Additional precautions

Answer 9

TIER 1: Standard/Routine practices include precautions for the care of all patients (if wounds or blood, risk of splash to/from mucous membranes, coughing/exposure to respiratory secretions, invasive procedures)
*PPE: gloves and gowns

TIER 2: Additional Precautions include precautions that are necessary for certain patients who are known or suspected to have an infection.
(Contact, droplet or airborne)

Question 10

Contact Precautions

• which infections?
• PPE?

Answer 10

MRSA, VRE, C Diff

PPE: gloves and gowns

Question 11

Droplet Precautions

• which infections?
• PPE?

Answer 11

Influenza, Covid19, Pneumonia, Meningitis, mumps, rubella

PPE: Gown, gloves, mask, eye protection (face shield, goggles)

Question 12

Airborne Precautions
(or droplet patients undergoing aerosol generating procedures)

• which infections?
• PPE?

Answer 12

SARS, TB, Measles

PPE: Gown, gloves, eye protection (face shield, goggles), N95 mask or respirator

Question 13

Donning PPE: order?

Answer 13

1. Wash hands
2. Gown on
3. Mask on
4. Eye protection on
5. Gloves on, cover gown cuffs

Question 14

Doffing PPE: order?

Answer 14

Gloves, gown, goggles, mask with hand wash after each:
1. Gloves off
2. Wash hands
3. Gown off
4. Wash hands
*exit the room if you are not 2 m away from patient
5. Goggles or face shield off – only touch straps (clean)
6. Wash hands
7. Mask off
8. Wash hands
9. Exit room and wash hands again

*use gravity and remove things point at the floor, don’t shake anything

Question 15

How do you greet a patient?

What do you tell them? What is NOD?

Answer 15

-Greet patient: call out “last name, Smith?”, watch out for “Do not acknowledge” (inmate)

Tell them my name, occupation, description of what I do (NOD), and ask permission

Question 16

Initial assessment: ABCCS

vs
Secondary assessment

Answer 16

Perform initial assessment (ABCCS) when you greet patient, ~5-15s: Airway, Breathing, circulation, consciousness, safety

Do a secondary assessment (LOC, ability to respond, ability to transfer, pain) every time the situation changes, ~1-2 min: Patient’s understanding, awareness, mobility

Question 17

Vital Signs: what is the TPR assessment?

Answer 17

TPR assessment: Temperature, Pulse, Respiration, BP (not technically a VS)

*Sonographers usually don’t measure Temp, but do measure BP

Question 18

Temperature normal value?

Answer 18

37

> 38 is a fever

Question 19

Pulse/HR normal value?

Answer 19

60-100 bpm

Question 20

Respiration rate normal value?

Answer 20

10-20 breaths/min (adult)

Question 21

Oxygen saturation target value for normal adult and COPD?

Answer 21

Target is 92-98% (normal adult)
<92% requires attention/monitoring

Target is 88-92% for COPD

Question 22

BP normal value?

Answer 22

120/80

high BP >140/90
Low is only a concern if <90/60

Question 23

Blood Glucose normal value?

Answer 23

4-7 mmol/L

Question 24

How do you put on a BP cuff?

Answer 24

patient sits quietly for 3-5 min
cuff 1” above elbow
tighten until you can just fit 2 fingers under
Line up arrow with artery

Question 25

Describe the auscultatory method to measure BP

Answer 25

AUSCULTATORY METHOD uses a stethoscope and sphygmomanometer. We listen for Korotkoff sounds as blood resumes flow through a gradually unconstrained artery.

Question 26

Describe the oscillometric method to measure BP

Answer 26

OSCILLOMETRIC METHOD uses an automated electronic device that converts flow vibrations in the arterial wall into electrical signals and displays the results on a digital readout. We position the cuff, and press “start”. The device inflates the cuff, deflates it, and beeps when the result displays on the readout.

Question 27

Does oxygen require a prescription?

Answer 27

Yes, oxygen is a drug and requires a prescription..... BUT, hypoxia is an emergency and most hospitals have a policy for emergency use

Question 28

Low flow versus High flow oxygen delivery equipment

Answer 28

Low flow = nasal cannula (prongs), simple face mask *may be applied by healthcare worker - lower flow than patient needs - for stable patients - not a precise amt High flow = Venturi, partial rebreather, non-rebreather, star wars, nebulizer *must be applied by respiratory therapist - flow meets/exceeds patients needs - unstable patients - precise oxygen delivery (controlled) - aerosolization can occur depending on device (ie deliver meds for asthma)

Question 29

What is a pulse oximeter? when do you use it and what does it tell us?

Answer 29

Pulse Oximeter - used for all breathless or acutely ill patients - Turn it on - Clip it on finger, nail facing up - See results: blood oxygen (SpO2) and pulse rate (PR) (Need warm hands and no nail polish for it to work; can also try toe)

Question 30

4 moments for hand hygiene are:

Answer 30

1. Before initial patient / patient environment contact 2. Before aseptic procedure 3. After body fluid exposure risk 4. After patient / patient environment contact

Question 31

Steps to wash hands

Answer 31

1. Wet hand with warm water 2. Soap 3. Rub palm to palm 4. Rub between fingers 5. Rub back of each hand 6. Rub finger tips in palm 7. Rub thumb and wrist 8. Rinse 9. Pat dry with paper towel 10. Use clean paper towel to turn off tap *don’t lean against sink or get shirt wet; never use patients personal sink