Certified Gastroenterology RN Infection Control and Safety Questions and Answers — Questions and Answers
Question 1: A nurse observes a technician open a package of sterile, single-use biopsy forceps and place them on the procedure cart's work surface 30 minutes before the patient is brought into the room. What is the most appropriate action for the nurse to take?
- Cover the forceps with a sterile drape until they are needed.
- Wipe the forceps with a high-level disinfectant before the procedure begins.
- Remove the forceps, discard them, and obtain a new sterile package just before use. (Correct answer)
- Proceed with using the forceps since the work surface was clean.
Correct answer: Remove the forceps, discard them, and obtain a new sterile package just before use.
Sterile items must be opened and introduced to the sterile field as close as possible to the time of use to minimize the risk of airborne and environmental contamination. Leaving the forceps exposed on a surface for an extended period, even if the surface was previously cleaned, compromises their sterility. The only safe action is to discard the potentially contaminated item and obtain a new one when the procedure is about to begin.
Question 2: According to the Spaulding classification system, flexible GI endoscopes that contact intact mucous membranes are categorized as which type of device, and what is the minimum required level of reprocessing?
- Critical; Sterilization
- Semi-critical; High-level disinfection (Correct answer)
- Non-critical; Low-level disinfection
- Semi-critical; Sterilization
Correct answer: Semi-critical; High-level disinfection
The Spaulding classification system categorizes medical devices based on the risk of infection. Flexible endoscopes contact mucous membranes but do not typically breach sterile tissue, classifying them as semi-critical devices. The minimum standard of reprocessing for semi-critical devices is high-level disinfection (HLD), which eliminates all vegetative microorganisms, mycobacteria, and viruses, but not necessarily high numbers of bacterial spores.
Question 3: A nurse is preparing for a colonoscopy on a patient with a confirmed Clostridioides difficile (C. diff) infection. In addition to standard and contact precautions, which infection control measure is most critical for the staff and environment?
- Ensuring the procedure room has negative air pressure.
- Using an alcohol-based hand rub for all hand hygiene.
- Wearing an N95 respirator during the procedure.
- Performing hand hygiene with soap and water and cleaning the room with a sporicidal disinfectant. (Correct answer)
Correct answer: Performing hand hygiene with soap and water and cleaning the room with a sporicidal disinfectant.
C. difficile forms spores that are resistant to alcohol-based hand sanitizers and many common disinfectants. Therefore, the most critical measures are to perform vigorous hand hygiene with soap and water to physically remove spores and to clean all environmental surfaces with an EPA-registered, sporicidal agent capable of killing C. difficile spores.
Question 4: When using a 0.55% ortho-phthalaldehyde (OPA) solution for manual high-level disinfection of a flexible endoscope, which parameters are most commonly cited in manufacturer and professional guidelines for efficacy in the United States?
- A minimum soak time of 12 minutes at or above 20°C (68°F). (Correct answer)
- A minimum soak time of 20 minutes at or above 25°C (77°F).
- A minimum soak time of 5 minutes at any room temperature.
- A minimum soak time of 10 minutes, with the solution heated to 30°C (86°F).
Correct answer: A minimum soak time of 12 minutes at or above 20°C (68°F).
The effectiveness of high-level disinfectants depends on strict adherence to validated parameters of time and temperature. For many OPA solutions used for manual reprocessing in the US, the standard is a minimum immersion time of 12 minutes at a temperature of at least 20°C (68°F). Shorter times, such as 5 minutes, are typically associated with higher temperatures (e.g., 25°C) and use within an automated endoscope reprocessor (AER).
Question 5: An endoscope is tested with an adenosine triphosphate (ATP) bioluminescence assay after manual cleaning but before high-level disinfection. The result is a 'FAIL,' indicating a high level of residual organic material. What is the priority action for the reprocessing technician?
- Proceed directly to high-level disinfection, as this step will eliminate any remaining bioburden.
- Document the failed result and send the endoscope for ethylene oxide (EtO) sterilization.
- Reclean the endoscope manually and repeat the ATP test to verify cleanliness before proceeding. (Correct answer)
- Rinse the endoscope with sterile water and re-test immediately.
Correct answer: Reclean the endoscope manually and repeat the ATP test to verify cleanliness before proceeding.
ATP testing is a quality control measure to verify the effectiveness of the manual cleaning step. A failed result indicates that the manual cleaning was inadequate and that organic debris, which can shield microorganisms from disinfectants, remains. The required action is to repeat the most critical step—manual cleaning—and then re-verify its effectiveness before the endoscope can proceed to high-level disinfection.
Question 6: A nurse is providing discharge instructions to a patient who underwent a colonoscopy with polypectomy. Which symptoms should the nurse instruct the patient to report immediately as potential signs of a post-procedure infection or perforation?
- Significant abdominal bloating and gas for up to 24 hours.
- Severe abdominal pain, fever, and chills. (Correct answer)
- A small amount of blood on the toilet tissue after the first bowel movement.
- Mild cramping that is relieved by passing gas.
Correct answer: Severe abdominal pain, fever, and chills.
While bloating, gas, and minor spotting of blood can be expected after a colonoscopy with polypectomy, the combination of severe, worsening abdominal pain, fever, and chills are hallmark signs of a serious complication, such as a perforation or post-polypectomy syndrome, which can lead to infection and peritonitis. These symptoms warrant immediate medical evaluation.
Certified Gastroenterology RN Infection Control and Safety Questions and Answers
A nurse observes a technician open a package of sterile, single-use biopsy forceps and place them on the procedure cart's work surface 30 minutes before the patient is brought into the room.
What is the most appropriate action for the nurse to take?