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HealthStream Regulatory Script Infection Control Release Date: June 2009 HLC Version: 602 Lesson 1: Introduction Lesson 2: Importance of Infection Control Lesson 3: The Chain of Infection Lesson 4: Infection Control Strategies Lesson 5: Employee Health and Personal Responsibility 1 1001 Introduction Welcome to the introductory lesson on infection control. IMAGE: 1001.JPG As your partner, HealthStream strives to provide its customers with excellence in regulatory learning solutions. As new guidelines are continually issued by regulatory agencies, we work to update courses, as needed, in a timely manner. Since responsibility for complying with new guidelines remains with your organization, HealthStream encourages you to routinely check all relevant regulatory agencies directly for the latest updates for clinical/organizational guidelines. If you have concerns about any aspect of the safety or quality of patient care in your organization, be aware that you may report these concerns directly to The Joint Commission. Page 1 of 4 2 1002 Course Rationale This course will teach you the basics of infection control. IMAGE: 1002.JPG You will learn: • How diseases are spread • How to help prevent the spread of disease in the healthcare setting Page 2 of 4 3 1003 Course Goals After completing this course, you should be able to: • Recognize the importance of infection control • Identify how infections spread • Recognize how to block the spread of infection • List your responsibilities for infection control NO IMAGE Page 3 of 4 4 1004 Course Outline This introductory lesson gave the course rationale and goals. FLASH ANIMATION Lesson 2 discusses the importance of infection control. Lesson 1: Introduction Lesson 2: The Importance of Infection Control • Healthcare-associated infection Lesson 3: The Chain of Infection • Links in the chain • Breaking the chain Lesson 4: Infection Control Strategies • Hand hygiene • Standard Precautions • Transmission-Based Precautions • Disinfection & sterilization Lesson 5: Employee Health & Personal Responsibility • Vaccinations • Exposure • When You Are Sick Lesson 3 describes how infections spread. Lesson 4 explains how to block the spread of infection. Finally, lesson 5 discusses your role and responsibility for infection control. Page 4 of 4 5 Lesson 2: The Importance of Infection Control 2001 Introduction & Objectives Welcome to the lesson on the importance of infection control. FLASH ANIMATION Lesson 2: The Importance of Infection Control After completing this lesson, you should be able to: • Healthcare-associated infection • Recognize the significance of healthcare-associated infection (HAI) • Identify the importance of infection control for preventing HAI Page 1 of 7 6 2002 Healthcare-Associated Infection Sometimes, patients come to the hospital with infections. These infections are community-acquired infections. IMAGE: 2002.JPG More often, patients do not have infections when they come to the hospital. Sometimes, these patients develop infections after being treated or admitted. An infection that develops in the hospital or after treatment is a healthcare-associated infection (HAI). Page 2 of 7 7 2003 Healthcare-Associated Infection: Frequency and Incidence In recent decades, the rate of HAI has increased. IMAGE: 2003.JPG Approximately two million hospital patients develop HAI each year. This is about 10% of all patients admitted to the hospital. Death from HAI may be as high as 90,000 patients per year. Caring for patients with HAI costs billions of dollars each year. Reasons for the increase include: • People coming to the hospital are sicker. This puts them at greater risk for infection. • Antibiotic-resistant infections have become more common. These infections can spread rapidly in the healthcare setting. Page 3 of 7 8 2004 Healthcare-Associated Infection: Prevention A good infection control program can help: • Protect patients from HAI • Protect hospital visitors and staff from infection IMAGE: 2005.GIF You play a key role in helping to prevent the spread of disease in your facility. You must: • Know the infection control practices used in your facility • Carefully follow those practices Page 4 of 7 9 2005 Healthcare-Associated Infection: The Joint Commission In 2009, the Joint Commission added a new National Patient Safety IMAGE: 2005a.jpg Goal: Goal 7: “Reduce the risk of health care associated infections” They now require hospitals to implement best practices and evidence-based guidelines to prevent: • Infections caused by multidrug-resistant organisms • Central line-associated infections • Surgical site infections Page 5 of 7 10 2006 Review Healthcare-associated infection (HAI): a. Is never fatal b. Develops in all hospitalized patients c. Develops after a patient has contact with the healthcare system d. All of the above e. None of the above MULTIPLE CHOICE INTERACTION Correct: C A: Incorrect. HAI leads to the death of as many as 90,000 patients each year. The correct answer is C. B: Incorrect. HAI develops in about 10% of hospitalized patients. The correct answer is C. C: Correct. D: Incorrect. The correct answer is C. E: Incorrect. The correct answer is C. Page 6 of 7 11 2007 Summary You have completed the lesson on the importance of infection control. NO IMAGE Remember: • Many patients develop HAI each year. • A good infection control program can help prevent HAI in patients. • A good infection control program also protects hospital staff and visitors. • All facility employees must do their part to prevent the spread of infection. Page 7 of 7 12 LESSON 3: The Chain of Infection 3001 Introduction & Objectives Welcome to the lesson on the chain of infection. After completing this lesson, you should be able to: • List the links in the chain of infection • Identify the weakest link in the chain. FLASH ANIMATION Lesson 3: The Chain of Infection • Links in the chain • Breaking the chain Page 1 of 13 13 3002 The Chain of Infection How do infections spread from person to person? IMAGE: 3002.JPG The process is called the chain of infection. Page 2 of 13 14 3003 Infectious Agents CLICK TO REVEAL The elements needed to transmit an infection include: • Infectious agent • Reservoir • Portal of exit • Method of transmission • Portal of entry • Susceptible host Click on each of the elements above for a basic definition. We will discuss each of these elements in greater detail on the following screens. Infectious agent Any disease-causing germ (pathogen). This includes viruses, fungi, bacteria, and parasites. Reservoir Where the pathogen lives or comes from. A reservoir can be an infected person. Food, water, an animal, and dirt can also be reservoirs. Portal of exit The way the pathogen leaves its reservoir. For example, suppose the reservoir is a person, and the pathogen is a cold virus. The pathogen can exit the person’s nose or mouth through a sneeze or a cough. Method of transmission How the pathogen moves from the reservoir to the susceptible host. In the sneeze example above, the pathogen is carried in the sneeze droplets. Other examples of transmission modes are sexual contact, animal bite, and needle stick. Portal of entry Where the pathogen enters the body of the susceptible host. In the sneeze example, the sneeze droplets could land on the susceptible host’s eyes, nose, or mouth. These areas would be the portal of entry. Broken skin is another common portal of entry for pathogens. Susceptible host Person who could get sick with a particular infection. In the sneeze example, almost everyone is a susceptible host when it comes to cold viruses. In other cases, some people are susceptible to a particular infection, and others are not. Factors such as weak immunity or lack of vaccination can make a host susceptible to disease. Page 3 of 13 15 3004 Infectious Agent Bacteria and viruses are the most common cause of HAI. FLASH ANIMATION Fungi also can cause HAI. However, this is less common. Examples of bacteria that can cause infection are: • Staphylococcus aureus • E. coli • Mycobacterium tuberculosis Examples of viruses that can cause infection are: • Influenza • Hepatitis B • Varicella zoster (chickenpox and shingles virus) CDC/Janice Carr /Jeff Hageman CDC/Janice Carr CDC/Erskine CDC Palmer/ M.L. Martin CDC/Janice Carr CDC/Erskine Palmer/B.G. Partin Page 4 of 13 16 3005 Reservoir Pathogens come from reservoirs. IMAGE: 3005.jpg The most common reservoir (or source) for HAI is an infected person. Other potential reservoirs are: • Food • Medications • Dust • Medical equipment • Computers Page 5 of 13 17 3006 Portal of Exit The portal of exit is the way a pathogen leaves its reservoir. FLASH ANIMATION Portals of exit from an infected person include: • The mouth, through coughing or speaking • The nose, through sneezing • Cuts, scratches, punctures, or wounds that allow blood to leave the body • Other openings in the body that allow body fluids to escape Page 6 of 13 18 3007 Method of Transmission The method of transmission is how a pathogen travels. FLASH ANIMATION From person to person, a pathogen can travel by: • Contact. This can be direct skin-to-skin contact. It also can be indirect contact. Indirect contact happens when an infected person touches a surface. Later, the susceptible host touches the same surface and picks up the pathogen. • Droplet. Respiratory droplets come from coughs, sneezes, or talking. They can travel only a few feet through the air. • Airborne respiratory particles. These tiny particles can travel a long way through the air from the reservoir to the susceptible host. • Bodily fluids. Blood and other bodily fluids can transmit disease if they contact a susceptible host’s broken skin or mucous membranes [glossary]. Page 7 of 13 19 3008 Portal of Entry A pathogen must enter a host to cause an infection. This happens through a portal of entry. FLASH ANIMATION Examples of portals of entry are: • Broken skin • Mucous membranes • Catheter access sites • Surgical wounds Page 8 of 13 20 3009 Susceptible Host A pathogen must find a susceptible host to cause infection. IMAGE: 3009.JPG Some people are more susceptible to infection than others. Many hospital patients are particularly susceptible to infection. These patients include: • Surgical patients • Patients with weakened immunity because of certain types of disease • Patients with weakened immunity because of taking certain drugs The very old and the very young have weaker immunity. Page 9 of 13 21 3010 The Weakest Link in the Chain To prevent the spread of infection, a link in the chain of infection must be broken. IMAGE: 3010.JPG The weakest link in the chain is the method of transmission. Therefore, most infection control strategies attack this link. We will take a closer look at these and other strategies in the next lesson. Page 10 of 13 22 3011 Review Assemble the chain of infection in order. FLASH INTERACTION: 3011.SWF Page 11 of 13 23 3012 Review The weakest link in the chain of infection is the: a. Reservoir b. Portal of entry c. Susceptible host d. Method of transmission MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: D] [RESPONSE FOR CHOICE A: Incorrect. [RESPONSE FOR CHOICE B: Incorrect. [RESPONSE FOR CHOICE C: Incorrect. [RESPONSE FOR CHOICE D: Correct. Page 12 of 13 24 3013 Summary You have completed the lesson on the chain of infection. NO IMAGE Remember: • There are six links in the chain of infection: • Infectious agent • Reservoir • Portal of exit • Method of transmission • Portal of entry • Susceptible host • To prevent the spread of infection, a link in the chain must be broken. • The weakest link in the chain is transmission. Most infection control strategies target this link. Page 13 of 13 25 Lesson 4: Infection Control 4001 Introduction & Objectives Welcome to the lesson on infection control. FLASH ANIMATION After completing this lesson, you should be able to: • Recognize good hand hygiene practices • Identify the major elements of Standard Precaution • List types of Transmission-Based Precautions • Define disinfection and sterilization Lesson 4: Infection Control Strategies • Hand hygiene • Standard Precautions • Transmission-Based Precautions • Disinfection & sterilization Page 1 of 18 26 4002 Hand Hygiene: Handwashing Proper hand hygiene is the single best way to stop the spread of infection. IMAGE: 4002.JPG The Joint Commission requires compliance with WHO [glossary] or CDC hand hygiene guidelines. Hands should be washed: • With warm water and soap • Using friction for at least 15 seconds • At the beginning and end of the work shift • Before eating, drinking, or applying cosmetics • Following contact with contaminated items or surfaces • After gloves are removed • After using the bathroom or blowing the nose • Before handling food, drugs, or cleaning supplies • Before and after each patient contact Page 2 of 18 27 4003 Hand Hygiene: Alcohol Rubs Alcohol rubs can be used instead of soap and water for hand hygiene. IMAGE: 4003.JPG These rubs are very effective at removing pathogens from the hands. To use an alcohol rub: • Apply enough rub to cover all of both hands. • Rub hands until dry. Do not rinse or wipe dry. You may use an alcohol rub almost any time hands should be washed. In fact, the CDC [glossary] currently recommends alcohol rubs for routine hand hygiene in most clinical situations. An exception is when hands are visibly dirty. In this case, wash with soap and water. Page 3 of 18 28 4004 Hand Hygiene: Other Jewelry and artificial nails can interfere with good hand hygiene. IMAGE: 4004.JPG They also can be good places for bacteria to hide. Therefore, healthcare workers should not wear artificial nails or an excessive amount of jewelry if they: • Have direct patient contact • Clean or prepare things that patients may use Natural nails should be kept no longer than ¼ of an inch long. Page 4 of 18 29 4005 Standard Precautions Proper hand hygiene is one part of Standard Precautions. IMAGE: 4005.JPG Standard Precautions are a set of tools for blocking the spread of bloodborne disease. To decide whether you need to use Standard Precautions, ask yourself: Is it possible that I could have contact with patient blood or other body fluids during this task? If the answer is “yes,” you must use Standard Precautions. The patient’s diagnosis does not matter. Standard Precautions are used with all patients. Page 5 of 18 30 4006 Standard Precautions: Engineering Controls Standard Precautions include the use of engineering controls. IMAGE: 4006.JPG Engineering controls are devices with built-in safety features. These features eliminate or minimize the risk of exposure to blood and body fluids. They should be examined and maintained on a regular basis. Common examples of engineering controls are: • Sharps disposal containers • Needle-less systems • Safety needles Page 6 of 18 31 4007 Standard Precautions: Work Practice Controls Standard Precautions also include work practice controls. IMAGE: 4007.JPG Work practice controls are ways of doing your job that minimizes your risk of exposure to blood and body fluids. Handwashing is an example of a work practice control. Other examples of work practice controls are: • Never recap used needles • Never point a needle toward any part of your body • Never bend or break used needles by hand • Always place used needles in a sharps disposal container Page 7 of 18 32 4008 Standard Precautions: Personal Protective Equipment Standard Precautions may require the use of personal protective equipment (PPE). IMAGE: 4008.JPG PPE consists of protective coverings that minimize the risk of exposure to blood or body fluids. For example: • Gloves • Gowns • Face shields • Masks • Ventilation devices Standard Precautions require you to use PPE in cases such as these: • Gloves must be worn if there is a possibility of contact with blood or body fluids. • A mask, protective eyewear, and a gown must be worn if there is a possibility of splashes or sprays of blood or body fluids. Page 8 of 18 33 4009 Transmission-Based Precautions CLICK TO REVEAL Remember: Standard Precautions are used with all patients. Patients with certain diseases require additional precautions to block the spread of disease. These precautions are: • Contact Precautions • Droplet Precautions • Airborne Precautions Click on each type of precautions to learn more. Contact Precautions Contact Precautions are used when a patient has, or may have, a disease spread by direct or indirect contact. Some examples of conditions that call for Contact Precautions are: • Scabies • Drug-resistant infections • Major wound infections • Herpes simplex To learn more, see the “Transmission-Based Precautions: Contact and Droplet” course. Droplet Precautions Droplet Precautions are used when a patients has, or may have, a disease spread by respiratory droplets. Some examples are: • Rubella • Diphtheria • Influenza • Meningococcal meningitis To learn more, see the “Transmission-Based Precautions: Contact and Droplet” course. Airborne Precautions Airborne Precautions are used when a patient has, or may have, a disease spread by tiny airborne particles. Some examples are: • TB • Measles To learn more, see the “Transmission-Based Precautions: Airborne” course. Page 9 of 18 34 4010 Disinfection and Sterilization Another aspect of infection control is disinfection and sterilization. IMAGE: 4010.JPG Routine patient care can lead to contamination of: • Environmental surfaces • Patient equipment • Medical devices Decontamination is achieved by: • Cleaning • Disinfecting • Sterilizing OSHA requires decontamination of equipment contaminated with blood or potentially infectious material. Page 10 of 18 35 4011 Disinfection & Sterilization: Cleaning The first step in the decontamination process is cleaning. This removes visible debris. IMAGE: 4011.JPG Some items must be soaked in a detergent solution. It is important to follow the manufacturer instruction for cleaning. You should also read the chemical instructions before use. After soaking, items generally are: • Scrubbed using friction • Rinsed with water • Dried to remove excess water Page 11 of 18 36 4012 Disinfection & Sterilization: Disinfection After cleaning, some items are disinfected to destroy pathogens. CLICK TO REVEAL There are two types of disinfection: • Low-level disinfection • High-level disinfection Low-level disinfection Low-level disinfection destroys most pathogens. Spores and some viruses may remain alive. This type of disinfection is used for low-risk items. These are items that come into contact with intact skin only. An example is environmental surfaces. Click on each to learn more. High-level disinfection High-level disinfection destroys all pathogens. This type of disinfection is used for moderate-risk items. These are items that may come into contact with mucous membranes or non-intact skin. Examples are devices that will be placed in a patient’s mouth during a procedure. Page 12 of 18 37 4013 Disinfection & Sterilization: Disinfection Disinfection is generally performed by soaking items in a solution. IMAGE: 4013.JPG The disinfectant solution must be: • Appropriate for the item • Approved by the FDA for disinfecting medical items Items must be soaked for the required amount of time. Some instruments may be disinfected automatically in machines. Always follow your facility’s policies for proper disinfection procedures. Page 13 of 18 38 4014 Disinfection & Sterilization: Sterilization Sterilization destroys all microbes. This includes viruses and all spores. IMAGE: 4014.JPG Sterilization is used for high-risk items. These are items that come into contact with sterile tissues or the bloodstream. Examples are: • Surgical instruments • Implantable devices [glossary] • Intravascular devices [glossary] Sterilization methods commonly used in the healthcare setting are: • Steam autoclave • Gas sterilization with ethylene oxide (EtO) Specific training is required to perform instrument sterilization. Page 14 of 18 39 4015 Disinfection & Sterilization: Aseptic Technique Using properly sterilized items is one part of aseptic technique. IMAGE: 4015.JPG Aseptic means “without microorganisms.” Aseptic technique is critical for protecting patients from infection during invasive procedures. For example, surgery is one important area where aseptic technique must be used. Aseptic technique for surgery includes: • Using sterilized items (as mentioned above) • Hand hygiene and the surgical scrub • Wearing proper surgical attire • Decontaminating the patient’s skin at the site of the procedure • Maintaining the sterile field Page 15 of 18 40 4016 Review Which patient groups require the use of Standard Precautions? a) All patients b) Only patients with AIDS c) Only patients with HIV infection d) Only patients with HBV or HCV infection e) Both C and D MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: A] [RESPONSE FOR CHOICE A: Correct. Standard Precautions are used with all patients. [RESPONSE FOR CHOICE B: Incorrect. The correct answer is A. Standard Precautions are used with all patients. [RESPONSE FOR CHOICE C: Incorrect. The correct answer is A. Standard Precautions are used with all patients. [RESPONSE FOR CHOICE D: Incorrect. The correct answer is A. Standard Precautions are used with all patients. Page 16 of 18 41 4017 Review A high-risk item such as a scalpel blade should be ________ prior to being used on a patient. a. Sterilized b. Low-level disinfected c. High-level disinfected MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: A] [RESPONSE FOR CHOICE A: Correct. [RESPONSE FOR CHOICE B: Incorrect. The correct answer is A. High-risk items should be sterilized. [RESPONSE FOR CHOICE C: Incorrect. The correct answer is A. High-risk items should be sterilized. Page 17 of 18 42 4018 Summary You have completed the lesson on infection prevention. NO IMAGE Remember: • The single most important thing you can do to stop the spread of disease is to practice proper hand hygiene. • Standard Precautions protect against the spread of bloodborne disease. These Precautions should be used with all patients. • Standard Precautions include engineering controls, work practice controls, and the use of PPE. • Patients with certain diseases must be isolated with Contact Precautions, Droplet Precautions, or Airborne Precautions. This is in addition to Standard Precautions. • Items become contaminated during patient care. Items must be decontaminated by cleaning, disinfecting, and/or sterilizing. • Using sterilized items is one part of aseptic technique. Aseptic technique should be used during all invasive procedures. This protects patients from infection. Page 18 of 18 43 Lesson 5: Employee Health & Personal Responsibility 5001 Objectives Welcome to the lesson on employee health and personal responsibility. FLASH ANIMATION After completing this lesson, you should be able to: • List immunizations for healthcare workers • Describe exposure follow-up practices Lesson 5: Employee Health & Personal Responsibility • Vaccinations • Exposure • When You Are Sick Page 1 of 7 44 5002 Immunizations To protect themselves and others, healthcare workers should have immunity to vaccine-preventable diseases. These diseases include: • Hepatitis B • Measles • Varicella (chickenpox / shingles) • Rubella • Mumps • Influenza IMAGE: 5002.JPG Ask your supervisor for more information on the immunization program at your facility. As an employee, you may be tested to check your: • Immune status • Need for immunization Page 2 of 7 45 5003 Exposure to Bloodborne Pathogens If you are ever exposed to blood or other bodily fluids, report this immediately. IMAGE: 5003.JPG This means that you should immediately report: • Needle-stick • Cut or puncture from any other contaminated sharp • Splash or spray of blood onto unprotected areas When you report an occupational exposure, your facility is responsible for making sure that you receive appropriate follow-up. Page 3 of 7 46 5004 Exposure to Other Communicable Diseases IMAGE: 5004.JPG At times, you may have contact with a patient before he or she is diagnosed with a disease that calls for isolation precautions. If this happens, you may need to report to occupational health for: • Assessment • Testing • Other follow-up procedures Sometimes, you will have immunity to the disease in question. In this case, nothing more will need to happen. Other times, you may have to stay home from work for a few days. You may also receive medications to keep from getting sick, depending on the patient’s diagnosis. Your supervisor and occupational health professionals will provide information and follow-up. Page 4 of 7 47 5005 When You Have a Communicable Disease If you have an infection, report to your supervisor before your shift starts. IMAGE: 5005.JPG In most cases, you will need to stay home from work until you have recovered or started treatment. Do NOT come to work if you have: • Fever • Conjunctivitis [glossary] • Vomiting or diarrhea • Coughing or sneezing • Unexplained rash Page 5 of 7 48 5006 Review Report to your supervisor immediately if: a. You cut yourself with a contaminated scalpel. b. You stick yourself with a contaminated needle. c. You are splashed in the face with blood, and you are not wearing goggles or a mask. d. All of the above e. None of the above MULTIPLE CHOICE INTERACTION Correct: D A: Incorrect. The correct answer is D. All of these exposures should be reported immediately. B: Incorrect. The correct answer is D. All of these exposures should be reported immediately. C: Incorrect. The correct answer is D. All of these exposures should be reported immediately. D: Correct. E: Incorrect. The correct answer is D. All of these exposures should be reported immediately. Page 6 of 7 49 5007 Summary You have completed the lesson on employee health and responsibilities NO IMAGE Remember: • Make sure you have been vaccinated against important diseases. • Report unprotected blood or body fluid exposures to your supervisor immediately. • Report any unprotected contact with communicable disease. • Do not come to work if you are sick. Page 7 of 7 50 Glossary antibacterial containing chemical agents that reduce or inhibit microbes blood blood or blood products including serum, packed cells, and plasma body substances any body fluid, secretion, or excretion: urine, feces, amniotic fluid, joint fluid, cerebrospinal fluid, wound drainage, saliva, breast milk, and others CDC Centers for Disease Prevention and Control communicable disease disease that can be transmitted directly or indirectly from one person to another community-acquired infection infection acquired by a patient prior to admission to a medical facility conjunctivitis highly contagious infection of the clear covering over the white part of the eye contamination introduction of infectious material onto a clean or sterile surface disinfection process of using chemical agents to kill most infectious organisms environmental surface items in the physical environment with which patients and staff routinely come in contact 51 ethylene oxide chemical used to sterilize heat-sensitive or delicate equipment that cannot be steam-autoclaved immunization protection against disease implantable device sterile medical device introduced into a patient using an invasive procedure and remaining in the patient for a period of time intravascular device sterile device that enters the bloodstream invasive procedure procedure requiring entry into the body or sterile tissue of a patient healthcare-associated infection infection that develops after treatment at or admission to a medical facility mucous membranes moist body lining, such as the lining of the nose and mouth pathogen microorganism or substance that can cause disease PPE personal protective equipment PPE Post-exposure prophylaxis 52 spore thick-walled reproductive form of an infectious agent capable of surviving extreme conditions sterilization process of killing all vegetative microorganisms as well as spores by exposure to heat, steam, or chemical agents vaccine-preventable disease disease for which there are known vaccines that will prevent infection WHO World Health Organization 53 Pre-Assessment 1. Healthcare-associated infection (HAI) is: a. An infection that cannot be treated in a standard way b. An infection that causes a patient to seek medical care c. An infection that results from exposure to a sick family member d. An infection that develops in the hospital or after medical treatment Correct: An infection that develops in the hospital or after medical treatment Rationale: HAI is infection that develops after contact with the healthcare system. 2. Each year, how many hospital patients develop HAI? a. About 20,000 b. About 200,000 c. About 2,000,000 d. About 20,000,000 Correct: About 2,000,000 Rationale: An estimated 2,000,000 hospital patients develop HAI each year. 3. Consider the chain of infection. In the chain, an example of a "reservoir" is: a. Sexual intercourse b. An infected person c. Mucous membranes d. Skin-to-skin contact Correct: An infected person Rationale: An infected person is a reservoir in the chain of infection. 4. Consider the chain of infection. In the chain, the nose during a sneeze is an example of a: 54 a. b. c. d. Portal of exit Portal of entry Susceptible host Method of transmission Correct: Portal of exit Rationale: Germs can exit the nose during a sneeze. Therefore, this is a portal of exit in the chain of infection. 5. Consider the chain of infection. Which link in the chain is most easily broken? a. Reservoir b. Portal of exit c. Portal of entry d. Method of transmission Correct: Method of transmission Rationale: It is easiest to break the chain of infection at transmission. Therefore, most infection control strategies target the method of transmission. 6. For routine hand hygiene in most clinical situations, the CDC recommends: a. Alcohol rubs b. Chlorine rinse c. Iodine compounds d. Plain soap and water Correct: Alcohol rubs Rationale: Under current CDC guidelines, alcohol rubs should be used for routine hand hygiene in most clinical situations. 7. To decide whether you need to use Standard Precautions with a particular patient, the best question to ask is: a. Am I up to date on my hepatitis B and hepatitis C vaccinations? 55 b. Does this patient have HIV infection or suspected HIV infection? c. Is it possible that I could have contact with body fluids during this task? d. Will I be able to wash my hands immediately after performing this task? Correct: Is it possible that I could have contact with body fluids during this task? Rationale: Standard Precautions should be used whenever there is a risk of contact with patient blood or body fluids. 8. Engineering controls are a part of Standard Precautions. These controls include: a. Safety needles b. Gloves and gowns c. The practice of not recapping needles d. Washing hands after contact with blood Correct: Safety needles Rationale: Safety needles are a type of engineering control. 9. Disinfection: a. Is a substitute for cleaning items to remove visible debris b. Is generally achieved by soaking items in a chemical solution c. Is performed by autoclaving or treatment with ethylene oxide d. Is most often used on items that will come in contact with a patient's bloodstream Correct: Is generally achieved by soaking items in a chemical solution Rationale: Disinfection is used to kill pathogens on low-risk and moderate-risk items. Most often, pathogens are killed by soaking items in a chemical solution for a period of time. 10. Healthcare workers should be immunized against: a. Scabies b. Anthrax c. Hepatitis B d. Bubonic plague Correct: Hepatitis B 56 Rationale: Healthcare workers should be immunized against several diseases, including hepatitis B 11. When you report an occupational exposure to patient blood, _____ is/are responsible for making sure you receive appropriate follow-up a. You b. The patient c. Your facility d. The public health authorities in your state Correct: Your facility Rationale: Your facility is responsible for follow-up care when you report an occupational exposure to blood. 12. There are three types of Transmission-Based Precautions. One type is: a. Droplet Precautions b. Standard Precautions c. Universal Precautions d. Drug-Resistant Precautions Correct: Droplet Precautions Rationale: Transmission-Based Precautions are: Contact Precautions, Droplet Precautions, and Airborne Precautions. 57 Final Exam 1. In recent decades, the rate of HAI has increased. One reason is: a. Antibiotic-resistant infections have become more common. b. Children receive more vaccinations with a risk of side effects. c. Alcohol-based hand rubs are not suitable for infection control. d. People live in more crowded places and are exposed to more germs. Correct: Antibiotic-resistant infections have become more common. Rationale: Antibiotic resistance contributes to HAI. 2. Each year, what percent of hospital patients develop HAI? a. About 1% b. About 10% c. About 50% d. Close to 100% Correct: About 10% Rationale: Each year, about 10% of hospital patients develop HAI. 3. Patient deaths from HAI have been estimated. The high end of the estimate is: a. 900 deaths per year b. 9,000 deaths per year c. 90,000 deaths per year d. 900,000 deaths per year Correct: 90,000 deaths per year Rationale: Patient deaths from HAI may be as high as 90,000 per year. 58 4. Consider the chain of infection. In the chain, an example of a "method of transmission" is: a. An infected person b. Skin-to-skin contact c. The mouth during a cough d. A contaminated medication Correct: Skin-to-skin contact Rationale: Skin-to-skin contact is a method of transmission in the chain of infection. 5. Consider the chain of infection. In the chain, broken skin is an example of: a. A reservoir b. A portal of entry c. A susceptible host d. An infectious agent Correct: A portal of entry Rationale: Germs can enter the body through broken skin. Therefore, broken skin is a portal of entry in the chain of infection. 6. Consider the chain of infection. Which link in the chain is most easily broken? a. Portal of exit b. Infectious agent c. Susceptible host d. Method of transmission Correct: Method of transmission Rationale: It is easiest to break the chain of infection at transmission. Therefore, most infection control strategies target the method of transmission. 7. When hands are visibly dirty, the CDC recommends hand hygiene with: a. Alcohol rub b. Chlorine rinse c. Soap and water d. Iodine compound 59 Correct: Soap and water Rationale: When hands are visibly dirty, wash with soap and water. Otherwise, use an alcohol rub. 8. Under Standard Precautions, gloves must be worn: a. For all patient tasks b. For all patients tasks when a hand-washing station is not nearby c. For all patients tasks when the patient is known to have HIV/AIDS d. For all patient tasks when there is a risk of contact with blood or body fluids Correct: For all patients tasks when there is a risk of contact with blood or body fluids Rationale: Gloves should be worn whenever there is a risk of contact with patient blood or body fluids. This is true regardless of the patient's infection status. 9. There are three types of Transmission-Based Precautions. One type is: a. Contact Precautions b. Standard Precautions c. Universal Precautions d. Drug-Resistant Precautions Correct: Contact Precautions Rationale: Transmission-Based Precautions are: Contact Precautions, Droplet Precautions, and Airborne Precautions. 10. Sterilization: a. Is a substitute for cleaning items to remove visible debris b. Is generally achieved by soaking items in a chemical solution c. Is performed by autoclaving or treatment with ethylene oxide d. Is most often used on low-risk items that come into contact with intact patient skin Correct: Is performed by autoclaving or treatment with ethylene oxide Rationale: Sterilization is used to kill pathogens on high-risk items. Pathogens are killed by steam autoclaving or treatment with ethylene oxide. 60 11. Healthcare workers should be immunized against: a. Varicella b. Diphtheria c. Tuberculosis d. Herpes simplex Correct: Varicella Rationale: Healthcare workers should be immunized against several diseases, including varicella (chickenpox/shingles). 12. If you experience a needle-stick injury while caring for a patient, you should: a. Change gloves and continue with your work b. Immediately report the injury to your supervisor c. Not worry about it if the patient does not have HIV/AIDS d. Go home for the day to rest, then return to work for your next shift Correct: Immediately report the injury to your supervisor Rationale: All occupational exposures should be reported immediately. Your facility is responsible for ensuring appropriate postexposure follow-up. 61