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Chapter04.docx

Chapter 04 - Principles of Infection Prevention and Control

Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition

MULTIPLE CHOICE

1. Approximately what percent of hospitalized patients develop a health care–associated infection?

a.

1%

b.

4%

c.

10%

d.

25%

ANS: B

Patients are at risk for developing infections during their hospital stay. A recent study estimated that 4% of hospitalized patients in the United States develop a health care–associated infection.

DIF: Recall REF: p. 60 OBJ: 1

2. Which of the following is considered the primary source of infection in the health care setting?

a.

Medical equipment

b.

Humans

c.

Food and water

d.

Carpet

ANS: B

Humans (patients, personnel, or visitors) are the primary sources for infectious agents in the health care setting.

DIF: Recall REF: p. 60 OBJ: 1

3. How do endotracheal tubes increase the risk of infection?

a.

By increasing bleeding risks

b.

Providing surfaces for biofilms to develop

c.

By reducing neutrophil effectiveness

d.

By increasing mucociliary escalator clearance

ANS: B

Endotracheal tubes allow pathogens to increase the risk of infection by impeding local host defenses and providing biofilms that may facilitate adherence of pathogens.

DIF: Application REF: p. 60 OBJ: 5

4. Which of the following factors increase the risk of surgical patients for developing postoperative pneumonia?

1. Obesity

2. Prolonged intubation

3. History of smoking

4. Elderly

a.

1 and 3 only

b.

2 and 4 only

c.

2, 3, and 4 only

d.

1, 2, 3, and 4

ANS: D

Patients at highest risk include elderly persons, the severely obese, those with chronic obstructive pulmonary disease (COPD) or a history of smoking, and those having an artificial airway in place for long periods. Strong cough mechanism actually helps to prevent atelectasis and pneumonia.

DIF: Recall REF: p. 60 OBJ: 4

5. What is the most common route of pathogen transmission in the hospital setting?

a.

Indirect contact

b.

Droplet transmission

c.

Airborne transmission

d.

Surgical transmission

ANS: A

Indirect contact transmission is the most frequent mode of transmission in the health care environment.

DIF: Recall REF: p. 61 OBJ: 3

6. Which of the following is an example of indirect contact transmission involving fomites?

a.

Use of a sterile needle on a pneumonia patient

b.

Use of a dirty laryngoscope blade on another patient

c.

Drinking tap water

d.

Inhaling tuberculosis pathogens in the emergency department

ANS: B

Instruments that have been inadequately cleaned between patients before disinfection or sterilization are an example of indirect contact transmission involving fomites.

DIF: Application REF: p. 62 OBJ: 3

7. If you are caring for a patient who is suspected of having SARS, at what distance from the patient is it recommended to wear an effective filtration mask?

a.

6 ft

b.

10 ft

c.

12 ft

d.

15 ft

ANS: A

Current HICPAC guidelines state it may be prudent to don a mask when within 6 ft of the patient or upon entry into the room of a patient who is on droplet isolation.

DIF: Application REF: p. 62 OBJ: 9

8. Which of the following diseases are transmitted primarily by airborne transmission?

1. Tuberculosis

2. Measles

3. Smallpox

4. Viral hemorrhagic fever

a.

1, 2, and 3 only

b.

1 and 4 only

c.

2, 3, and 4 only

d.

1, 2, 3, and 4

ANS: A

The pathogens transmitted by the airborne route include Mycobacterium tuberculosis, varicella-zoster virus (chickenpox), and rubeola virus (measles). Airborne transmission of variola (smallpox) has been documented and airborne transmission of SARS, monkeypox, and the viral hemorrhagic fever virus has been reported, although not proved conclusively.

DIF: Recall REF: p. 62 OBJ: 3

9. What techniques are used by most hospitals to reduce host susceptibility to infection?

a.

Immunization

b.

Blood testing

c.

Surveillance

d.

Having patients wear N95 mask

ANS: D

Hospital efforts to decrease host susceptibility focus mainly on employee immunization and chemoprophylaxis.

DIF: Recall REF: p. 64 OBJ: 6

10. What vaccination does OSHA require hospital employers to provide?

a.

Tuberculosis

b.

Smallpox

c.

Hepatitis B

d.

Streptococcus pneumoniae

ANS: C

OSHA mandates that employers offer hepatitis B vaccination.

DIF: Recall REF: p. 62 OBJ: 6

11. What is the first step in equipment processing for reuse on another patient?

a.

Drying the equipment

b.

Cleaning the equipment

c.

Disinfecting the equipment

d.

Sterilizing the equipment

ANS: B

Cleaning is the first step in all equipment processing.

DIF: Recall REF: p. 63 OBJ: 8

12. Which of the following statements is NOT true regarding the use of soaps to clean equipment?

a.

Soaps act by lowering the surface tension.

b.

Soaps work poorly in hard water.

c.

Soaps have good bactericidal activity.

d.

Soaps can help remove organic material.

ANS: C

Soaps act by lowering surface tension and forming an emulsion with organic matter. Unfortunately, soaps have little bactericidal activity and work poorly in hard water. A detergent refers to a substance (usually a chemical agent but sometimes a physical one) applied to inanimate objects that destroys disease-causing pathogens but not spores.

DIF: Application REF: p. 63 OBJ: 7

13. What should be used to wipe down the surface of devices that cannot be immersed in water?

a.

70% ethyl alcohol

b.

Warm soapy water

c.

Strong detergent

d.

Bleach

ANS: A

The surface of the device should be disinfected using a 70% ethyl alcohol solution or the equivalent.

DIF: Recall REF: p. 70 OBJ: 7

14. Which of the following organisms is NOT destroyed by a disinfection agent?

a.

Gram-negative cocci

b.

Bacterial spores

c.

Gram-positive rods

d.

Viruses

ANS: B

Disinfection describes a process that destroys the vegetative form of all pathogenic organisms on an inanimate object except bacterial spores.

DIF: Recall REF: p. 70 OBJ: 7

15. What solution should be used to disinfect the surfaces of the room of a patient who was infected with C. difficile?

a.

70% ethyl alcohol

b.

5.25% sodium hypochlorite

c.

1% sodium benzoate

d.

5% iodine solution

ANS: B

Because C. difficile may form spores that are resistant to commonly used surface disinfectants, the CDC recommends the use of 1:10 dilution of 5.25% sodium hypochlorite (household bleach) and water for routine environmental disinfection in the rooms of patients with C. difficile.

DIF: Recall REF: p. 73 OBJ: 7

16. Which of the following statements is false regarding the use of alcohol disinfectants?

a.

Their activity drops when diluted below 50% concentration.

b.

Alcohols are good for surface cleaning of stethoscope bells and diaphragms.

c.

They can damage rubber tubing.

d.

They are considered sporicidal.

ANS: D

Alcohol disinfectants in the health care setting refer to either ethyl alcohol or isopropyl alcohol. Neither is considered a high-level disinfectant as a single agent, they are not sporicidal, and they do not penetrate protein-rich materials. Their activity drops when diluted below 50% concentration. Alcohols are inactivated by protein and can damage rubber, plastics, and the shellac mounting of lensed instruments. Alcohol wipes are a good choice for disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface disinfectants for stethoscopes, ventilators, and manual ventilation bags.

DIF: Recall REF: p. 73 OBJ: 7

17. Which of the following characteristics is false for iodophors as disinfectants?

a.

Water soluble

b.

Nonstaining

c.

Less irritating to tissue

d.

Bacteriostatic

ANS: D

Unlike iodine tinctures, iodophors are water soluble, nonstaining, and less irritating to tissue. Iodophors are bactericidal, virucidal, and tuberculocidal.

DIF: Recall REF: p. 73 OBJ: 7

18. Which of the following statements is false regarding the use of glutaraldehyde?

a.

It is a true sterilizing agent when used properly.

b.

It can retain activity up to 90 days once activated.

c.

It is used for disinfection on surfaces due to cost.

d.

It can cause significant tissue inflammation in workers who use it.

ANS: B

Glutaraldehyde (saturated dialdehyde) is a commonly used high-level disinfectant/sterilant. When aqueous solutions of 2% glutaraldehyde are alkalized (“activated”) to a pH between 7.5 and 8.5, glutaraldehyde can kill vegetative bacteria, M. tuberculosis, fungi, viruses, and spores in less than 10 min (see Table 4-3). This sporicidal activity qualifies glutaraldehyde as a true sterilizing agent.

DIF: Recall REF: p. 74 OBJ: 7

19. What is the recommended dilution level of bleach according to the CDC for cleaning up blood spills?

a.

1:1

b.

1:5

c.

1:10

d.

1:20

ANS: C

The CDC recommends a 1:10 dilution of bleach (or an Environmental Protection Agency [EPA]-registered disinfectant) to disinfect blood spills.

DIF: Recall REF: pp. 77-78 OBJ: 7

20. What is the most common, efficient, and easiest sterilization method?

a.

ETO

b.

Flash sterilization

c.

Steam sterilization

d.

Use of hydrochlorofluorocarbon

ANS: C

Moist heat in the form of steam under pressure is the most common, efficient, and easiest sterilization method.

DIF: Recall REF: p. 71 OBJ: 7

21. Which of the following statements is false regarding the use of ETO for sterilization?

a.

It is harmless to rubber and plastics.

b.

It will penetrate prewrapping.

c.

Acute exposure is of little consequence.

d.

It is useful for equipment that cannot be autoclaved.

ANS: C

Unfortunately, acute exposure to ETO gas can cause airway inflammation, nausea, diarrhea, headache, dizziness, and even convulsions.

DIF: Recall REF: pp. 70-72 OBJ: 7

22. Which of the following is the most common source of patient infections?

a.

Large volume nebulizers

b.

Small volume nebulizers

c.

Internal circuits of a ventilator

d.

Oxygen therapy devices

ANS: A

Large volume nebulizers are the worst offenders.

DIF: Recall REF: p. 73 OBJ: 4

23. Which of the following steps for disinfection of a bronchoscope is false?

a.

The first step is cleaning the scope.

b.

Disinfection is done by immersion in a liquid disinfectant.

c.

The device is stored lying flat to promote drying.

d.

Drying techniques can include forced air.

ANS: C

Store in a manner so that the bronchoscope is vertical to prevent recontamination and facilitate drying.

DIF: Recall REF: p. 72 OBJ: 7

24. Which of the following organisms has/have been associated with health care–associated infections in patients using a poorly disinfected bronchoscope?

1. M. tuberculosis

2. Pseudomonas aeruginosa

3. Klebsiella

a.

1 and 3 only

b.

2 and 3only

c.

2 only

d.

1, 2, and 3

ANS: A

Health care–associated infections associated with bronchoscopes have been most commonly reported with M. tuberculosis, nontuberculosis mycobacterium, and P. aeruginosa.

DIF: Recall REF: p. 79 OBJ: 4 | 5

25. Which of the following statements is/are true regarding the use of disposable respiratory care equipment?

1. Recent research supports their use as a cost-effective measure.

2. Many quality issues exist.

3. Reusing the equipment is often done.

a.

1 and 3 only

b.

2 and 3only

c.

2 only

d.

1, 2, and 3

ANS: D

Three major issues are involved in using disposables: cost, quality, and reuse.

DIF: Recall REF: p. 80 OBJ: 8

26. Which of the following are categories under Expanded Precautions?

1. Contact Precautions

2. Droplet Precautions

3. Standard Precautions

4. Airborne Infection Isolation

a.

1 and 2 only

b.

1, 2, and 4 only

c.

2, 3, and 4 only

d.

1, 2, 3, and 4

ANS: B

There are four categories of Expanded Precautions: Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment.

DIF: Recall REF: p. 69 OBJ: 8

27. What is the minimum recommended time for handwashing in the health care environment?

a.

5 sec

b.

15 sec

c.

30 sec

d.

60 sec

ANS: B

Hand hygiene includes handwashing with both plain or antiseptic-containing soap and water for at least 15 sec.

DIF: Recall REF: p. 63 OBJ: 6

28. Which of the following diseases is transmitted through direct contact?

a.

HIV

b.

Pertussis

c.

Hepatitis B

d.

Hepatitis C

ANS: A

The only one of those diseases that is transmitted through direct contact is HIV. Hepatitis B and C are both indirect contact, and pertussis is through droplet transmission.

DIF: Recall REF: p. 61 OBJ: 4

29. Which of the following diseases travels through droplet mode?

a.

Influenza

b.

Rickettsia

c.

Malaria

d.

Lyme disease

ANS: A

Influenza travels through droplet mode. Rickettsia, Lyme disease, and malaria are vector-borne.

DIF: Recall REF: p. 61 OBJ: 4

30. What is included in a Prevention Bundle?

1. The use of multiple evidence-based best practices to prevent device-related infection.

2. Recent research supports the use of cost-effective measurements.

3. An ongoing process of monitoring patients and personnel for the acquisition of infection in the health care setting.

4. Using prophylactic antibiotic therapy on all hospitalized patients.

a.

1 and 2 only

b.

1, 2, and 3 only

c.

2, 3, and 4 only

d.

1, 2, 3, and 4

ANS: B

Prevention Bundle is the use of multiple evidence-based best practices to prevent device-related infection.

DIF: Recall REF: p. 62 OBJ: 6

31. Small volume nebulizers produce bacterial aerosols that have been commonly associated with which of the following diseases?

a.

Pseudomonas aeruginosa

b.

Measles

c.

Small pox

d.

Nosocomial pneumonia

ANS: D

Small volume nebulizers produce bacterial aerosols that have been associated with nosocomial pneumonia.

DIF: Application REF: p. 73 OBJ: 5

32. What is the purpose of an inspiratory HEPA filter in a ventilator circuit?

a.

The purpose is to serve as a heated thermistor that prevents condensation from forming in the circuits.

b.

It prevents pathogens from being expelled into the surroundings.

c.

When placed between the ventilator and the circuit, it can eliminate bacteria.

d.

None of the above.

ANS: C

The purpose of an inspiratory HEPA filter, when it is placed between the ventilator and the external circuit, is to eliminate bacteria from the driving gas and prevent retrograde contamination back into the ventilator.

DIF: Application REF: p. 73 OBJ: 8

33. The unit residence asked you to reduce the risk of contamination caused by condensation in the circuit of a mechanically ventilated patient. Which of the following would help to reduce or eliminate condensation in this patient’s circuit?

a.

Using a heat and moisture exchange (HME)

b.

By draining the circuit on a daily basis

c.

By not using any form of heater at all

d.

By lowering the temperature in the heater

ANS: A

By replacing an active humidification system by a passive humidification one (HME), there will be less condensation in the circuit because no water is being used to heat and moisten the air, but instead the patient’s own body heat is used. Draining the circuit daily, not using heat, or lowering the heater temperature is not acceptable and may place the patient at risk of infection caused by inspissated secretions among other consequences.

DIF: Analysis REF: p. 73 OBJ: 6

34. Which of the following is the simplest level of infection control based on the recognition that all blood, body fluids, secretions, and excretions may contain transmissible infections agents?

a.

Contact Precautions

b.

Droplet Precautions

c.

Standard Precautions

d.

Airborne Infection Isolation

ANS: C

The term Standard Precautions refers to the simplest level of infection control based on the recognition that all blood, body fluids, secretions, and excretions (with the exception of sweat) may contain transmissible infectious agents.

DIF: Recall REF: p. 63 OBJ: 8