Preventing Perioperative Disease Transmission Chapter 7 (Nicola)

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1

Absence of microorganisms

asepsis

2

Device to accomplish steam or gas sterilization

autoclave

3

Amount of gross organic debris or the number of microorganisms on an object at any given time

bioburden

4

A method for testing the sterilization capability of a sterilizer; contains microorganisms that are killed when exposed to a sterilization process; only method of guaranteeing the sterility of an item(s)

biological indicator

5

Specifically designed for use with a prevacuum steam sterilizer to test for air entrapment

Bowie-Dick test

6

Mechanical process used by ultrasonic cleaners during which air pockets implode to dislodge debris and soil from the crevices and serrations of surgical instruments and equipment

Cavitation

7

A method of cleaning instruments in which the chosen cleaning solution uses the process of binding ions, such as iron and magnesium, in the solution to prevent their deposit on the surface of surgical instruments

chelation

8

Internal or external monitor that changes color when exposed to the sterilization process; only indicates that the sterilization process has occurred; it does not guarantee the sterility of the item

Chemical indicators

9

The growth and collection of microbes into a group that lives in a particular area, such as the colonization of S. aureus in the nares of humans

colonization

10

Soiled with gross debris or by the presence of microbes

Contaminated

11

A general term used to describe the various types of flexible or rigid scopes used to view the body’s internal structures

Endoscope

12

Sterility determined by how a sterile package is handled rather than time elapsed; the package is considered sterile until opened, or until the integrity of the packaging material is compromised

event-related sterility

13

A process of quickly sterilizing unwrapped items (such as a surgical instrument that has been dropped on the floor and is needed right away) using prevacuum or gravity steam sterilizers

immediate-use steam sterilization

14

Placing an item in a container so it is completely covered by a liquid, such as immersing a surgical instrument in glutaraldehyde

immersion

15

Complete, with no breaks or tears

integrity

16

Level of disinfection in which most microorganisms are killed except spores

intermediate-level disinfection

17

Calendar days that are sequentially numbered through the year; often used when maintaining sterilization records (i.e., February 1 would be the 32nd day of the Julian calendar)

Julian date

18

The opening in a tube or vessel

lumen

19

Microorganism that is capable of causing disease

pathogen

20

Area of sterility maintained by the surgical team during a procedure

sterile field

21

The condition of being permeable; capable of allowing the passage of fluids or substances

permeability

22

(1) Procedure to render an individual incapable of reproduction; (2) process by which all microorganisms, including spores, are destroyed

sterilization

23

A machine used to remove minute organic particles and soil from the areas of instrumentation hardest to reach by manual or other mechanical methods of cleaning; the washer utilizes the process of cavitation for cleaning instruments

ultrasonic cleaner

24

Both organisms benefit from and depend on one another to a certain extent

Mutualism

25

What colonizes within the human intestine, obtains nutrients from the food that humans eat.

Escherichia coli

26

produces vitamin K, which is essential to the blood-clotting process in humans

E. coli

27

Two organisms work together to achieve a result neither could obtain alone
Fusobacteria and spirochetes work together to cause a disease known as trench mouth

Synergism

28

One organism benefits but second organism neither benefits nor is harmed

Commensalism

29

To a certain extent they benefit humans by occupying space and preventing other potentially harmful microbes from colonizing
Indigenous microflora on the skin of humans obtain nutrients, but do not affect the skin or human body

competitive exclusion

30

Two organisms occupy the same area with no effect on each other.

Neutralism

31

One microorganism inhibits or interferes with the growth of another.
Example: A microbe produces waste products that are toxic to the neighboring microbes

Antagonism

32

One organism benefits and the host is harmed. Commensal microbes that become opportunistic by entering through a surgical skin incision.

Parasitism

33

Endoparasites, such as intestinal worms, cause an infection and deplete the body of nutrition

Examples of Parasitism

34

What are opportunistic by entering through a surgical skin incision.

Commensal microbes

35

Infections acquired in a hospital - UTI

Nosocomial infections

36

What kind of virus causes the common cold

Airborne viruses

37

According to CDC study on nosocomial infections

32% of all HAIs are urinary tract infections
22% are surgical site infections (SSIs)(SSIs)See surgical site infection (SSIs) See surgical site infection

38

CDC study Heath Care Infections counted for

15% are pneumonia (lung infections)
14% are bloodstream infections

39

All living cells are classified into two groups

prokaryotes and eukaryotes
Bacteria

40

Which bacteria is less complex organisms whose organelles are not membrane bound like those of the eukaryotes

prokaryotes

41

Which bacteria cellular structure is complex, and this classification includes protozoa; fungi; green, brown and red algae; and all plant and animal cells.

eukaryotes

42

What is size, shape, and arrangements of bacteria

Morphology

43

What is round-shaped bacteria

Coccoid
coccus, singular form; cocci, plural form)

44

What is paired bacteria

Diplococci

45

What is Streptococci

chain of bacteria

46

What is Staphylococci

Cluster of bacteria

47

What is Bacillus

rod-shaped bacteria
(bacillus, singular form; bacilli, plural)

48

What is Spirilla

spiral-shaped bacteria

49

Ability of a microbe to move by itself

Motility

50

What are long thin structure attached to the outside of the cell; uses whipping motion to provide motility to the cell

Flagella

51

What are fine, short, hair like extensions located on the surface of the cell; their coordinated, rhythmic movement allows the cell to move

Cilia

52

What are the oxygen requirements of Obligate aerobes

require level of oxygen found in a typical room

53

What are the oxygen requirements of Obligate anaerobes

will not grow if there is any amount of oxygen present in the environment

54

Which bacteria retain the crystal violet and therefore are a purple color

Gram-positive

55

Which bacteria do not retain the crystal violet and are red from the safranin stain

gram-negative

56

What bacteria, such as Mycobacterium tuberculosis, do not consistently stain red or purple.

Gram-variable bacteria

57

What is the bacterial species capable of forming spores

Spore forming (sporulation)

58

Example of Spore forming bacteria

Clostridium
the genetic material of the cell is enclosed in a protein capsule TB for example

59

Spore forming bacteria cause a number of diseases, including

botulism, anthrax, tetanus and acute food poisoning

60

Most common bacterial pathogen in the o.r

Staphylococcus
(type of bacteria commonly found on the skin and hair as well as in the noses and throats)

61

Types of Staphylococcus - S. aureus

Toxic shock syndrome
Osteomyelitis (bone infection)
Postoperative SSI (surgical site infection
Endocarditis (inflammation of the inner layer of the heart)

62

What is a sore, red throat

Streptococcus

63

Streptococcus - S pneumoniae

Bacterial pneumonia
lung infection

64

Streptococcus - S. pyogenes

Rheumatic fever: If you have had this you will be put on an antibiotic before surgery

Necrotizing fasciitis: Flesh eating disease

65

What Aerobic Gram-Negative Cocci causes inflammatory disease leading to salpingitis

Neisseria gonorrhoeae

66

What Aerobic Gram-Negative Cocci causes Otitis media in children

Moraxella catarrhalis
Inflammation of the middle ear

67

Which Aerobic, Microaerophile Gram-Negative Bacilli, Spirochetes causes Legionnaires' disease

Pseudomonas
Severe form of pneumonia

68

Which Aerobic, Microaerophile Gram-Negative Bacilli, Spirochetes causes Chronic gastritis, Stomach ulcers, and Peptic ulcers

Helicobacter pylori
Stomach bacteria

69

What family of penicillin has been used so much people have become resistant to it

Vanomycin
VRE

70

Which Facultative Anaerobic Gram-Negative Bacilli can cause Respiratory tract infections, Bacterial pneumonia (elderly), Otitis media, Eye infections,
Septic arthritis and Cellulitis

influenza
commonly known as "the flu"

71

Which Facultative Anaerobic Gram-Negative Bacilli is associated with Health care–associated UTIs,
Wound and burn infections, Ankylosing spondylitis (sequelae of a Klebsiella infection)

Klebsiella pneumoniae

72

What Anaerobic Gram-Positive Bacteria can cause Gas gangrene infection

Clostridium

73

What Mycobacteria causes Tuberculosis

Mycobacterium tuberculosis

74

What is the Mycobacteria responsible for sexually transmitted disease that men and women

Chlamydia

75

Surgical procedures performed on known ...... carriers require implementing isolation precautions, in addition to isolation PPE, an National Institute of Occupational Safety and Health (NIOSH)–approved respirator must be worn

Tuberculosis

76

What are nonliving particles that are completely reliant on the host cell for survival

viruses

77

What contains either DNA or RNA and a protein coat that encases the nucleic acid.

A virus

78

Transmission: Percutaneous or permucous in blood, serum, and other body fluids

Description: Causes inflammation of the liver, jaundice, cirrhosis, and, in some cases, liver cancer

Hepatitis B (HBV)

79

Transmission: Blood-borne RNA; transmitted through blood and blood products

Description: Asymptomatic when acute; may be carried for 25 years; causes chronic hepatitis, cirrhosis, liver cancer

Hepatitis C

80

Transmission: Blood or other body fluids

Description: Compromises immune system

Human immunodeficiency virus (HIV)

81

Transmission: Contact with fluid from lesions

Description: Causes localized blister like eruptions; can also cause keratocon junctivitis, acute retinal necrosis, meningoencephalitis

Herpes simplex virus (HSV)

82

Transmission: Direct contact with another person

Description: Warts

Papillomavirus

83

Transmission: Direct contact with body fluids

Description: Infects salivary glands or viscera; opportunistic infection in patients with HIV or hepatitis

Cytomegalovirus (CMV)

84

Transmission: Exact mode of transmission unknown; thought to be by percutaneous inoculation with brain tissue or cerebral spinal fluid from infected persons; transmission has been associated with use of contaminated instruments; longer sterilization times required.

Description: Rapidly progressive fatal central nervous disease characterized by dementia, myoclonus

Creutzfeldt-Jakob Disease (CJD)

85

What is built of proteins and do not contain DNA or RNA. They attack the brain, which is why the diseases they cause are called subacute spongiform encephalopathies

Prions
is short for “proteinaceous infectious particle.”

86

What are two common forms of prions

Scrapie (a disease that infects sheep and goats) and bovine spongiform encephalopathy (commonly called mad cow disease).

87

What have two categories : unicellular protozoans and multicellular protozoans.

Parasites

88

What are popularly known as worms. Those that are most common in the human population are tapeworms, flukes, and roundworms.

Helminths

89

What are pork tapeworms that can migrate out of the intestinal tract and travel to muscle and brain tissue, and the eyes. They can cause palpable lumps in soft tissues, blurred vision and retinal detachment, and when located in the brain tissue cause seizures, ataxia, headaches, and possibly death.

Cysticeri - (Taenia solium)

90

What are eukaryotic organisms that are either unicellular yeasts or multicellular molds and mushrooms

Fungi

91

What reproduce either sexually or asexually by producing spores; a true spore is formed by either asexual cleavage or sexual meiosis. diseases are called mycoses (the plural of mycosis).

Fungi reproduction

92

What is a vaginal yeast infection and Trench mouth (thrush)

Candida albicans
Common Fungal Infections

93

What common fungal infection preys on immunocompromised patients prone to serious infections of the brain, meninges, and heart valves Patients intubated or who have indwelling venous catheter or other type long-term indwelling catheter should be monitored for infection

Candida albicans

94

What is Pneumocystis pneumonia (PCP),

Pneumocystis jiroveci is the most common opportunistic infection in persons with HIV

95

What fungus, caused by the common bread mold, if it enters the bloodstream can destroys the cranial bones, the brain tissue will be invaded.

zygomycosis

96

Since a high percentage of individuals are carriers of ........ the threat is considerable enough to warrant the use of hair covers and masks

S. aureus

97

What are inanimate objects that may contain infectious microorganisms including walls, floors, cabinets, furniture and equipment.

Fomites

98

The two primary sources of SSI risk to the patient are the ..........encountered in contaminated procedures and the ........ of the skin.

endogenous flora
resident flora

99

What factor increases risk of SSI for geriatric and pediatric patients have lower immunological defenses.

Age

100

What factor increases risk of SSI for diminished blood flow, larger wound sizes, and the difficulty of handling adipose tissue make these patients more susceptible to infection.

Obesity

101

What factor increases risk of SSI for patients in poor health or who have an inadequate nutritional intake generally have a predisposition to infection.

General health

102

What factor increases risk of SSI for patients at greater risk of infection from their own endogenous flora

Carriers of S. aureus or MRSA

103

What factor increases risk of SSI for infections at other body sites increase the chance of SSI. Bacteria in the bloodstream enter and infect the surgical site.

Remote infections

104

What factor increases risk of SSI for infection rates increase parallel to the duration of preoperative stay. Patients are exposed to higher numbers of antibiotic-resistant strains of bacteria within the hospital.

Preoperative hospitalization

105

What factor increases risk of SSI for infection rates are higher in patients with compromised immune systems; patients who have been treated with certain medications, including steroids or chemotherapy agents; and patients who have recently undergone radiation therapy.

Preexisting illness and related treatment

106

Procedure-related risk factors that increase the danger of SSI due to the use of razor blades that may leave nicks and scrapes on the skin

Preoperative hair removal

107

Procedure-related risk factors that increase the danger of SSI - what is Clean-contaminated (Class II), contaminated (Class III), and dirty (Class IV) cases carry a higher risk of infection as do cases that compromise blood flow to a particular area, such as coronary artery bypass procedures, where one or both internal mammary arteries are used.

Type of procedure

108

Procedure-related risk factors that increase the danger of SSI due a longer anesthetic and operative times have an accompanying increase in time for bacterial contamination to occur, increased tissue damage, and greater immunosuppression. Surgical team members become more fatigued, which may lead to breaks in sterile technique.

Duration of procedure

109

What is the growth and collection of microbes into a group that lives in a particular area

Colonization

110

What is Absence of Microorganisms

Asepsis

111

What is the substance that destroys/kills bacteria

Bactericidal

112

What is substance that inhibits the growth and reproduction of bacteria

Bacteriostatic

113

What is the number of microbes or amount of organic debris on an object at any given time

Bioburden

114

What is the presence of pathogenic materials

Contamination

115

What is the contamination of a person or object by another

Cross-contamination

116

What is it called to reduce to an irreducible minimum the presence of pathogenic material

Decontamination

117

What sterility is determined by how a package is handled rather than time elapsed; a package is considered sterile until opened or the integrity of packaging material is damaged

Event-related sterility

118

What is an inanimate object that harbors microorganisms

Fomite

119

What is an agent that destroys fungus

Fungicide

120

What is microbes that normally reside below the skin surface or within the body

Resident flora

121

What is an infection, usually accompanied by fever, that results from the presence of pathogenic microorganisms

Sepsis

122

What is a microbes that reside on the skin surface and are easily removed

Transient flora

123

What is a process in which most but not all microorganisms located on animate surfaces, such as the skin, are destroyed.

Antisepsis

124

What classification does the CDC and FDA give surgical instruments, devices that enter the vascular or urinary systems (needles, catheters), implantable items (wires, screws, joint replacements, mesh, sutures), and any monitors or probes that enter deep tissue layers or cavities. These items should be sterilized.

Critical status

125

What classification does the CDC and FDA give surgical instruments, devices that come into contact with mucous membranes or non-intact skin carry a lesser risk of infection due to the properties of resistance of intact mucosal linings to many commonly encountered bacterial spores. Examples include: laryngoscopes, anesthesia and respiratory equipment, and some endoscopes. High-level disinfection should be used for items in this category

Semi-critical status

126

What classification does the CDC and FDA give surgical instruments, items that come into contact with a patient’s intact skin and clean environmental equipment items pose the least risk of infection. Examples include blood pressure cuffs, pulse oximeters, OR transport stretchers, and other furniture. These items require either intermediate-level or low-level disinfection.

Non-critical status

127

The physical removal of blood, body fluids, and/or gross debris (bioburden) from an inanimate object.

Cleaning

128

Destruction (3 levels) of pathogenic microorganisms or their toxins or vectors by direct exposure to chemical or physical agents.

Disinfection

129

What kills all microorganisms except spores and prions (CJD).

High-level disinfection

130

What kills (ineffective against spores) most microorganisms, including bacteria, most viruses and fungi. M. tuberculosis and HBV

Intermediate-level disinfection

131

What kills some fungi and viruses, and most bacteria, but is NOT effective against spores and M tuberculosis.

Low-level disinfection

132

What provides destruction of all microorganisms in or about an object with steam (flowing or pressurized), chemical agents (alcohol, phenol, heavy metals, or ethyl-ene oxide gas), high-velocity electron bombardment, or ultraviolet radiation.

Sterilization

133

What is a high-level disinfectant. Its common commercial name is Cidex.

Glutaraldehyde
20 mins disinfecting
10 hrs = sterile

134

What color should the test strip turn when testing Cidex to ensure its 2%strength

Yellow

135

What is an effective disinfectant for surfaces, floors, and equipment. It is such an effective and fast-acting solution, and the CDC recommends its use in cleaning blood and body fluid spills.

Sodium Hypochlorite
household bleach

136

What is usually used as a concentrate with detergent additives and is diluted with tap water. It is used to disinfect large areas such as floors and countertops and is used on a general basis as a health care facility cleaning agent.

Phenol (Carbolic Acid)

137

Who is involved in the “turnover” of the room, which marks the preparation for the next procedure

The surgical technologist, along with environmental services personnel

138

What should be available in the sterile field for soaking and cleaning if instruments.

Sterile water

139

What should never be used to soak instruments as the salt in the solution could cause pitting and corrode the metal

saline

140

After which type of case should the floor be cleaned with a phenolic detergent and all equipment and furniture should be wiped down with 70% alcohol solution.

Dirty Cases

141

Design of the decontamination area

Filtered air is exhausted to the outside of the health care facility.
The minimum air exchange rate is 10 times per hour.
Temperature should be maintained between 64° and 70°F with a humidity of 35% to 72%.
Negative air pressure is maintained

142

What facilitates the removal of protein materials such as blood.

Proteolytic enzymatic cleaner

143

What facilitates the removal of fatty material such as adipose tissue and bone marrow

Lipolytic enzymatic cleaner

144

What is an organic substance that aids in the chemical reaction of breaking down organic debris, used as a chemical soaking solution, need warm water and dilution.

enzymatic chemical cleaner

145

Cleaning solutions are manufactured specifically for use in ....... cleaners. The solution may contain a surfactant (to enhance wetting ability) and chelating agents.

Ultrasonic

146

Products usually used for hand cleaning of items and/or for presoaking. Mechanical action is required to assist in removing the soil. Surgical instruments must be thoroughly rinsed after being placed in the detergent

Manual Detergent

147

Liquid solution that is available in three different pH levels. Neutral-pH product: Least corrosive to surgical instruments but less effective at removing substantial amount of organic soil.

Washer Decontaminator

148

The process of binding minerals, such as iron and magnesium in the solution to prevent their deposits on the surface, causing spotting

Chelation

149

What are catalyst that aid in the breakdown of organic soil and blood

Enzymatic

150

What is the action of dispersing two liquids not capable of being mixed

Emulsification

151

What is the action by which the solubility of a substance is increased within a solution

Solubilization

152

What does Impervious to moisture mean

Waterproof

153

What types of peel pack is used for steam and EtO sterilization

Paper-plastic combinations

154

What types of peel pack is used for EtO and Sterrad

Tyvek-plastic combination

155

Heavy instrument sets should be

no more than 25lbs

156

If what is trapped in the lumen it may prevent steam from contacting the inner surface. To prevent this entrapment of a residual amount of distilled water should be left inside the lumen. The water will boil during sterilization, turning to steam and displacing the air within the lumen.

Air

157

What indicates the date of sterilization. This date is the number of the calendar day (1-365/366); for example, the .... date for February 27, 2013 is 58 and March 5, 2013 is 64.

Julian Date

158

What requires a Cycle Time
Contents 270°F Drying Times
Instrument set, 4 minutes 20–30 minutes Wrapped
Instrument set, 3 minutes NA unwrapped, no lumen instrument

Steam sterilizer

159

What sterilizer uses moister and heat to kill microbes, this process is accelerated when pressure is added

Steam sterilization

160

What generate their own steam When steam is supplied from an outside source, the walls of the chamber are preheated before the steam is allowed into the chamber. This is accomplished with a metal jacket that is built around the chamber. The space between the jacket and chamber is filled with steam to preheat the chamber walls when the machine is turned on.

Autoclaves

161

Which sterilizer is slower than prevacuum/dynamic-air-removal sterilizers because gravity is relied on to remove the air.

Gravity displacement Sterilizer

162

What is referred to as an immediate use sterilization for unwrapped items

Flash sterilization

163

What are the three methods of monitoring the sterilization process

Mechanical
Chemical
Biological

164

Which indicators are used externally and internally to verify that items have been exposed to sterilizing conditions

Chemical Indicators

165

What is the spore used for ETO indicators

Bacillus atrophaeus

166

The inside of wrappers containing linens or other sterile items is considered sterile except for

1 inch perimeter around the outside edge of the wrapper

167

The integrity of the wrapper

must be checked before opening

168

The surgical gown is considered sterile in front

2 inches below the neckline to table level; bilaterally; and sterile gloved hands to 2 inches above elbows

169

Sterile surgical team members should either pass whilst

facing one another or back to back by rotating 30 degrees

170

A non sterile team member must maintain a distance of

12 inches from any sterile item, area, or field to prevent contamination

171

When draping a Nonsterile table to create a sterile field the Nonsterile individual should

cuff the hands in the underside folds of the drape or table cover to avoid contaminating the top surface