Infection Control & Prevention Flashcards

A patient with suspected pulmonary tuberculosis is being transported through the hospital corridor for a CT scan. Which combination of precautions is most appropriate during transport?

Answer: The patient wears a surgical mask; transport staff wear N95 respirators; notify receiving department in advance

During transport of a suspected TB patient, the patient should wear a surgical mask (to contain droplet nuclei from source), while transport staff and any exposed personnel wear N95 respirators. The receiving department must be notified in advance so they can prepare an airborne infection isolation room. Staff do not need N95s if the patient is masked and transport is brief, but the patient's mask is the primary source-control measure.

A healthcare worker accidentally recaps a used needle using the two-handed technique and sustains a needlestick injury. After reporting the incident, HIV post-exposure prophylaxis (PEP) is considered. The source patient's HIV status is unknown and the patient refuses testing. What is the most appropriate next step regarding PEP?

Answer: Initiate PEP within 72 hours based on risk assessment of the exposure and the source patient's clinical profile

PEP decisions should not be delayed pending source patient testing. When HIV status is unknown and the patient refuses testing, PEP should be initiated within 72 hours (ideally within 2 hours) based on epidemiological risk assessment — considering the clinical profile of the source (e.g., risk factors, CD4 count if known, medications). Waiting forfeits the narrow window of PEP efficacy; legal or forced testing is not an ethically or legally appropriate approach in most jurisdictions.

During a surgical procedure, the scrub technician's sterile glove is torn by a sharp bone fragment but the inner glove remains intact. The outer glove is replaced immediately. Which statement best describes the infection control implication?

Answer: No sterile field breach has occurred because the inner glove remained intact and the outer glove was replaced

Double-gloving is specifically recommended to mitigate glove perforation risk. When the outer glove is perforated but the inner glove remains intact, the sterile barrier has not been breached — the inner glove continues to protect both the patient and the healthcare worker. The outer glove should be replaced promptly. There is no requirement to halt the procedure, re-scrub, or change the inner glove if it has not been breached. Pressure differential contamination is not a validated mechanism requiring routine inner glove change.

A hemodialysis unit identifies a cluster of Hepatitis C virus (HCV) infections among patients who did not share dialysis machines. Investigation reveals correct hand hygiene compliance but identifies a shared medication cart used by nurses. Which infection control failure most likely explains the cluster?

Answer: Cross-contamination via multidose vials or shared medication supplies on the cart without adequate aseptic technique

HCV outbreaks in hemodialysis units where machines are not shared most commonly result from environmental contamination via medication preparation — specifically, multidose vials, saline flush syringes, or medication supplies on shared carts that become contaminated with blood. HCV can survive on environmental surfaces for up to 6 weeks. HCV is not airborne (ruling out option D), and contact precautions are not routinely required for HCV-positive dialysis patients (ruling out option C). Shared equipment through the medication cart is the classic vector when machines are excluded.

A patient on contact precautions for carbapenem-resistant Enterobacterales (CRE) requires an urgent echocardiogram at the bedside. The portable ultrasound probe must be used on intact abdominal skin. After the procedure, which disinfection level is required for the probe?

Answer: Intermediate-level disinfection using an EPA-registered hospital disinfectant with tuberculocidal claim

According to the Spaulding classification, a probe used on intact skin is classified as a 'non-critical' item. Non-critical items require intermediate-level disinfection (not high-level, which is for semi-critical items like endoscopes). For a CRE patient, an EPA-registered disinfectant with demonstrated activity against CRE (including tuberculocidal EPA-registered products) is appropriate. High-level disinfection or sterilization would be required only if the probe contacts mucous membranes or non-intact skin. Low-level disinfection alone may be insufficient given the heightened risk of CRE environmental contamination.

A hospital epidemiologist is investigating an elevated rate of central line-associated bloodstream infections (CLABSIs) in the ICU. Compliance with the central line bundle — hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection, and daily necessity review — is documented at 100%. Which less-obvious factor should be investigated next?

Answer: The concentration and contact time of chlorhexidine used during dressing changes, and whether alcohol-impregnated port protectors are in use

When bundle compliance is 100% yet CLABSIs persist, the next step is to scrutinize the quality and fidelity of bundle components rather than their mere completion. Key areas include: whether chlorhexidine dressing changes use the correct concentration (2% CHG preferred) with adequate contact time; whether alcohol-impregnated port protectors (passive disinfection caps) are applied to all hub access points; and whether needleless connector decontamination technique is adequate. Wearing gowns during routine care, isolation room pressure, and handover proximity are not established CLABSI risk factors.