NMC OSCE Infection Prevention and Control 2 — Questions and Answers
Question 1: What is the chain of infection, and why is understanding it important for infection prevention?
- Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host — breaking any link prevents infection (Correct answer)
- A chain worn by infection control nurses for identification
- The sequence of antibiotics used to treat infections
- The order in which patients develop hospital-acquired infections
Correct answer: Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host — breaking any link prevents infection
The chain of infection describes the six links required for infection transmission: infectious agent (pathogen), reservoir (where it lives), portal of exit (how it leaves the reservoir), mode of transmission (how it spreads), portal of entry (how it enters the new host), and susceptible host. Breaking any single link prevents infection — this is the basis of all infection prevention strategies.
Question 2: A patient is colonised with MRSA. What is the difference between colonisation and infection, and what are the appropriate nursing actions?
- Colonisation means MRSA is present but not causing illness; infection means it is causing clinical signs. Both require contact precautions, but only infection requires antibiotic treatment (Correct answer)
- There is no difference — both require immediate IV antibiotics
- Colonisation is more serious than infection
- Colonised patients do not need any special precautions
Correct answer: Colonisation means MRSA is present but not causing illness; infection means it is causing clinical signs. Both require contact precautions, but only infection requires antibiotic treatment
MRSA colonisation means the organism is present (usually in the nose, skin, or groin) without causing symptoms. Infection means MRSA is causing clinical illness (wound infection, bacteraemia). Colonised patients require contact precautions (apron, gloves), decolonisation treatment (mupirocin nasal ointment, chlorhexidine body wash), and screening of contacts. Systemic antibiotics are only used for active infection.
Question 3: What is the recommended procedure for decontaminating a blood spillage on a hard floor surface?
- Apply chlorine-based disinfectant (10,000 ppm available chlorine) or granules to the spill, leave for the recommended contact time, then clean up wearing appropriate PPE (Correct answer)
- Mop it up with water immediately
- Cover with paper towels and leave for the cleaning team
- Spray with alcohol and wipe
Correct answer: Apply chlorine-based disinfectant (10,000 ppm available chlorine) or granules to the spill, leave for the recommended contact time, then clean up wearing appropriate PPE
Blood spills require chlorine-based disinfectant at 10,000 ppm (parts per million) of available chlorine, or proprietary chlorine-releasing granules. The process: wear PPE (gloves, apron), apply granules/disinfectant, allow the recommended contact time (typically 2-5 minutes), clean up the waste into a clinical waste bag, then clean the area with detergent and water. A lower concentration (1,000 ppm) is used for general environmental disinfection.
Question 4: Norovirus has been identified on a hospital ward. What specific infection control measures should be implemented?
- Close the ward to new admissions, isolate symptomatic patients, use soap and water hand hygiene, enhanced environmental cleaning with chlorine-based products, cohort nursing (Correct answer)
- Continue normal operations with standard precautions
- Prescribe antibiotics to all patients on the ward
- Transfer all patients to other wards immediately
Correct answer: Close the ward to new admissions, isolate symptomatic patients, use soap and water hand hygiene, enhanced environmental cleaning with chlorine-based products, cohort nursing
Norovirus outbreaks require: bay/ward closure to new admissions, isolation or cohorting of symptomatic patients, soap and water handwashing (alcohol gel is less effective against norovirus), enhanced cleaning with chlorine-based disinfectant (1,000 ppm), dedicated nursing staff, and restriction of staff movement between areas. Symptomatic staff must be excluded until 48 hours after symptoms resolve.
Question 5: What are standard precautions in infection prevention and control, and when should they be applied?
- A set of precautions applied to ALL patients at ALL times regardless of known infection status, including hand hygiene, PPE use, safe sharps management, and environmental cleaning (Correct answer)
- Precautions only applied when a patient has a known infection
- Wearing gloves for all patient contact
- Hand hygiene at the start and end of each shift only
Correct answer: A set of precautions applied to ALL patients at ALL times regardless of known infection status, including hand hygiene, PPE use, safe sharps management, and environmental cleaning
Standard precautions are the minimum infection prevention practices applied to all patients in all healthcare settings, regardless of suspected or confirmed infection status. They include: hand hygiene, use of PPE based on risk assessment, respiratory hygiene/cough etiquette, safe handling and disposal of sharps, safe handling of linen, environmental cleaning, and waste management.
Question 6: A patient has a urinary catheter in situ. What are the key nursing interventions to prevent catheter-associated urinary tract infection (CAUTI)?
- Daily assessment of the need for the catheter, maintain a closed drainage system, keep the drainage bag below bladder level, perform meatal hygiene, ensure adequate fluid intake (Correct answer)
- Empty the drainage bag only when completely full
- Routinely change the catheter every 3 days
- Irrigate the catheter with antiseptic solution daily
Correct answer: Daily assessment of the need for the catheter, maintain a closed drainage system, keep the drainage bag below bladder level, perform meatal hygiene, ensure adequate fluid intake
CAUTI prevention follows the EPIC3 guidelines: review the need for catheterisation daily and remove as soon as possible, maintain a closed drainage system (minimise disconnections), keep the drainage bag below bladder level but off the floor, perform routine meatal hygiene with soap and water, ensure adequate hydration, and secure the catheter to prevent traction. Routine catheter changes, bladder washouts, and antiseptic instillation are NOT recommended.
NMC OSCE Infection Prevention and Control 2
What is the chain of infection, and why is understanding it important for infection prevention?