HCA Infection Control & Safety Procedures 2 — Questions and Answers
Question 1: Which of the following best describes the difference between 'cleaning', 'disinfection', and 'sterilization'?
- Cleaning removes visible soil; disinfection kills most pathogens but not all spores; sterilization destroys all microorganisms including spores (Correct answer)
- Cleaning kills all pathogens; disinfection removes visible soil; sterilization reduces spores only
- All three terms describe the same process using different chemical strengths
- Sterilization is used for surface cleaning; disinfection is used for surgical instruments only
Correct answer: Cleaning removes visible soil; disinfection kills most pathogens but not all spores; sterilization destroys all microorganisms including spores
These three processes represent increasing levels of microbial elimination and are applied according to the item's risk level and intended use.
The Spaulding Classification guides decontamination levels: non-critical items contacting only intact skin (blood pressure cuffs, stethoscopes) require cleaning and low-level disinfection; semi-critical items contacting mucous membranes (respiratory equipment) require high-level disinfection; critical items entering sterile tissue (surgical instruments) require sterilization. HCAs typically perform cleaning and low-level disinfection of resident care equipment using facility-approved disinfectants, following contact time requirements on the product label.
Question 2: What is the significance of 'contact time' when using disinfectant wipes on surfaces?
- The surface must remain visibly wet for the full contact time specified on the label for the product to achieve its antimicrobial claim (Correct answer)
- Wiping once with the product and immediately drying is sufficient for full disinfection
- Contact time only applies to high-level disinfectants, not routine surface wipes
- A longer contact time means the disinfectant is harmful and should be used less
Correct answer: The surface must remain visibly wet for the full contact time specified on the label for the product to achieve its antimicrobial claim
Disinfectant products must maintain surface wetness for the full label-specified contact time to achieve their stated kill rate.
Disinfectant efficacy claims (e.g., 'kills 99.9% of bacteria') are validated at specific contact times (typically 1–10 minutes depending on the product). If the surface dries before the contact time is reached, the antimicrobial process is incomplete. HCAs must use enough product to keep the surface wet for the required time. This is a commonly overlooked IPAC compliance issue in care settings and a focus of infection control audits in BC and Ontario.
Question 3: A resident with scabies has been identified in the care home. What type of precautions are required?
- Contact precautions: gown and gloves for all direct contact, dedicated equipment, and treat clothing and bedding per provincial IPAC guidance (Correct answer)
- Airborne precautions: N95 respirator required for all staff entering the room
- Standard precautions are sufficient as scabies is not a serious infection
- Droplet precautions only for procedures generating respiratory secretions
Correct answer: Contact precautions: gown and gloves for all direct contact, dedicated equipment, and treat clothing and bedding per provincial IPAC guidance
Scabies is transmitted via direct skin contact and contaminated fomites; contact precautions protect staff and prevent facility-wide outbreaks.
Scabies (Sarcoptes scabiei mite infestation) is highly contagious via direct skin-to-skin contact or contact with contaminated bedding and clothing. In long-term care, scabies outbreaks can spread rapidly among residents, staff, and families. Contact precautions require gown and gloves for all direct care, dedicated equipment, bagging and laundering bedding and clothing at high temperature, and treatment of the resident and (per public health guidance) exposed staff and close contacts. Crusted (Norwegian) scabies is highly infectious and requires enhanced precautions.
Question 4: Which of the following is the correct procedure for disposing of used isolation PPE?
- Remove and dispose of PPE inside the isolation room or in the anteroom before leaving, then perform hand hygiene (Correct answer)
- Remove PPE in the hallway outside the room to avoid contaminating the room doorway
- Place all used PPE in the sharps container for safe disposal
- PPE can be reused for the next visit to the same resident's room without changing
Correct answer: Remove and dispose of PPE inside the isolation room or in the anteroom before leaving, then perform hand hygiene
Removing PPE at the point of use (inside or anteroom) prevents carrying contamination into the corridor and general facility environment.
The correct doffing location for contact/droplet PPE is inside the isolation room or in the anteroom (if available) immediately before exiting. Removing PPE in the hallway risks dispersing pathogens to the general environment. The doffing sequence (gloves → eye protection → gown → mask/respirator) is designed to move from most to least contaminated. After each doffing step, hand hygiene is performed. Single-use disposable PPE is never reused; reusable equipment (goggles, face shields) is disinfected per facility protocol.
Question 5: An HCA is assigned to care for a resident on Vancomycin-Resistant Enterococcus (VRE) precautions. What does this mean for care planning?
- Contact precautions with gown and gloves for all direct care, dedicated equipment, enhanced environmental cleaning, and hand hygiene with soap and water preferred (Correct answer)
- The resident must be moved to a hospital for specialized treatment
- VRE only requires standard precautions as it rarely causes active infection
- Airborne precautions are required as VRE spreads through respiratory secretions
Correct answer: Contact precautions with gown and gloves for all direct care, dedicated equipment, enhanced environmental cleaning, and hand hygiene with soap and water preferred
VRE is an antibiotic-resistant bacterium transmitted via direct contact; contact precautions and environmental cleaning are the cornerstones of prevention.
Vancomycin-resistant Enterococcus colonizes the gastrointestinal tract and can cause serious infections resistant to vancomycin (a last-resort antibiotic). It survives for extended periods on surfaces. Contact precautions include: gown and gloves for all direct care; dedicated equipment (stethoscope, blood pressure cuff, thermometer) kept in the room; enhanced room cleaning with sporicidal agents if recommended; hand hygiene preferring soap and water (similar to C. diff due to spore-like environmental persistence of VRE). Residents do not require hospitalization solely for VRE colonization.
Question 6: When is it appropriate for an HCA to re-enter a resident's isolation room without changing their PPE?
- It is never appropriate to re-enter without fresh PPE; all PPE must be replaced between each room entry after an exit (Correct answer)
- It is acceptable to re-enter quickly without new PPE if the visit was less than 2 minutes ago
- Re-entering with the same gloves is allowed if only touching the same surfaces
- PPE can be reused indefinitely for the same isolation resident during a single shift
Correct answer: It is never appropriate to re-enter without fresh PPE; all PPE must be replaced between each room entry after an exit
Once PPE is removed after exiting the room, it must be fully replaced before re-entering; there is no time-based exception.
Once PPE is removed, it is considered contaminated or compromised and must not be reused. Even within a single shift, re-entering an isolation room requires a fresh, complete set of PPE (per the required precaution level) and hand hygiene before donning. The rationale is that doffed PPE may have deposited pathogens on the HCA's hands during removal, and partial re-entry without full PPE risks both HCA and environmental contamination. No time-based or contact-duration exceptions exist in current IPAC guidelines.
HCA Infection Control & Safety Procedures 2
Which of the following best describes the difference between 'cleaning', 'disinfection', and 'sterilization'?