NMC CBT Infection Prevention and Control 2 — Questions and Answers
Question 1: According to the WHO '5 Moments for Hand Hygiene', which is NOT one of the five moments?
- Before touching a patient
- After exposure to body fluids
- Before putting on personal protective equipment (Correct answer)
- After touching patient surroundings
Correct answer: Before putting on personal protective equipment
The 5 Moments are: before touching a patient, before clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings. PPE donning is not one of the five.
The WHO 5 Moments: (1) Before patient contact; (2) Before clean/aseptic procedure; (3) After body fluid exposure; (4) After patient contact; (5) After touching patient surroundings. Use alcohol-based hand rub unless hands are visibly soiled, then use soap and water.
Question 2: A patient has C. difficile infection. Which hand hygiene method is required and why?
- Alcohol hand rub as it kills spores
- Soap and water because alcohol does not destroy C. diff spores (Correct answer)
- Either method is acceptable
- No hand hygiene needed if gloves were worn
Correct answer: Soap and water because alcohol does not destroy C. diff spores
C. diff produces spores resistant to alcohol. Thorough handwashing with soap and water is required to physically remove them.
C. difficile produces resilient spores surviving months on surfaces. Alcohol is ineffective against them. Handwashing with soap and water for 15-20 seconds physically removes spores. Additional measures: isolation in a side room; gloves and aprons; chlorine-based cleaning (1000 ppm); dedicated equipment; antimicrobial stewardship.
Question 3: A nurse is inserting a urinary catheter. Which aseptic technique should be used?
- Standard ANTT
- Surgical ANTT (Correct answer)
- Clean technique with non-sterile gloves
- Standard precautions only
Correct answer: Surgical ANTT
Catheterisation involves a large key-part entering a sterile body cavity, requiring Surgical-ANTT with a sterile field and sterile gloves.
ANTT classifies procedures as Standard-ANTT (simple, key-parts protected by micro field, e.g., cannulation) or Surgical-ANTT (complex, requiring main critical aseptic field/sterile drape). Catheterisation is Surgical-ANTT because it involves inserting into a sterile body cavity with significant CAUTI risk.
Question 4: What is the recommended thermal disinfection temperature for automated washer-disinfectors?
- 65 degrees C for 1 minute
- 71 degrees C for 3 minutes
- 80 degrees C for 1 minute (Correct answer)
- 90 degrees C for 5 minutes
Correct answer: 80 degrees C for 1 minute
NHS HTM 01-01 guidelines specify minimum 80 degrees C for 1 minute at the load.
Department of Health HTM 01-01 recommends 80 degrees C for 1 minute (A0 value >=600 for general instruments). Higher temperatures for shorter durations or lower for longer may also work. The process includes pre-rinse, main wash with detergent, thermal disinfection, and drying.
Question 5: A healthcare worker sustains a needlestick injury. What is the correct sequence of immediate actions?
- Apply a dressing and attend occupational health next day
- Encourage bleeding, wash with soap and running water, report immediately, attend A&E/occupational health urgently (Correct answer)
- Squeeze the wound, apply antiseptic, inform manager within 24 hours
- Wash, take patient's blood for testing, start post-exposure prophylaxis
Correct answer: Encourage bleeding, wash with soap and running water, report immediately, attend A&E/occupational health urgently
Encourage bleeding under running water, wash with soap (not antiseptic), report through the incident system, attend occupational health or A&E urgently.
Protocol: (1) Encourage bleeding under running water, do not suck; (2) Wash with soap and water, do not scrub or use antiseptic; (3) Cover with waterproof dressing; (4) Report immediately via incident system (Datix); (5) Attend occupational health/A&E urgently. HIV PEP must start within 72 hours (ideally 1 hour). Source patient blood testing requires consent.
Question 6: Which waste bin is used for infectious clinical waste requiring incineration?
- Yellow bin with yellow lid (Correct answer)
- Orange bin with orange lid
- Yellow bin with black lid (tiger stripe)
- Purple bin with purple lid
Correct answer: Yellow bin with yellow lid
Yellow bins with yellow lids are for clinical waste requiring incineration, including highly infectious, anatomical, and cytotoxic waste.
UK healthcare waste colour coding (HTM 07-01): Yellow/yellow = incineration (highly infectious, anatomical, cytotoxic); Orange/orange = alternative treatment then landfill; Yellow/black (tiger stripe) = offensive/hygiene waste; Purple = cytotoxic only; Black = domestic; Blue = pharmaceutical.
NMC CBT Infection Prevention and Control 2
According to the WHO '5 Moments for Hand Hygiene', which is NOT one of the five moments?