Deck 4: Infection Prevention and Control

Question 1

Within a steam sterilizer,at a temperature of 100° C (212° F),the water condensation and the steam are the same temperature.This scientific phenomenon is called ___________________ and will __________________.

A) steam saturation; not kill microorganisms
B) steam distribution; promote microbial kill
C) sterilization; kill all microorganisms to 106
D) saturated steam; kill microbes at 106

Answer 1

A
When a cold item is introduced to steam,some of the steam releases its latent energy to the object and changes back to liquid water.This phenomenon allows items to be heated much more rapidly in steam than in dry heat.The phenomenon of steam changing to liquid water is called condensation,and the steam and the liquid water are at a temperature of 212° F (100° C)when this occurs.At this point,the steam is said to be saturated.This 212° F (100° C)temperature is insufficient to kill microorganisms,however.To kill microorganisms,a saturation temperature of 250° F (121° C)is necessary.

Question 2

A swab of a fluid collection from an edematous,red,and suppurative postoperative wound is sent to the microbiology lab for culture,sensitivity,and Gram stain.The surgeon expects that the result will show a gram-positive coccus.This Gram stain designation is based on the:

A) ability to cause plasma to coagulate and form a microscopic clot.
B) physical and chemical properties of the cell wall.
C) formation of aerobic clustered spheres.
D) appearance of a thicker and brownish-colored cell wall.

Answer 2

B
Gram staining is a procedure for staining bacteria; it is the first step in classifying and differentiating bacteria into two large groups (gram-positive and gram-negative)based on the chemical and physical properties of their cell walls.A gram-positive microorganism has a thicker cell wall than a gram-negative microorganism.

Question 3

The evening before the procedure was scheduled,the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation,four flexible coated retractor blades,and an unsterilized internal paper inventory form.The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants,but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220° F.The appropriate sterilization option for these instruments and devices would be:

A) hydrogen peroxide gas plasma sterilization for everything.
B) steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately.
C) steam sterilization for the implant sets, hydrogen peroxide gas plasma for the retractors and paper inventory form, wrapped separately.
D) steam sterilization for everything with a shortened dry time.

Answer 3

B
Low-temperature hydrogen peroxide gas plasma sterilization should be used for moisture- and heat-sensitive items and when indicated by the device manufacturer.Cellulosic-based products,such as paper and linen,are not recommended for use with plasma systems,because they tend to absorb the vapor and cause the sterilization cycle to abort.

Question 4

The mechanism of lethality (microbial death)with steam sterilization is achieved with this event:

A) time, temperature, and steam pressure.
B) reduced and limited mitosis within the bioburden.
C) saturated vaporization of the microbial cytoplasm.
D) denaturation and coagulation of enzyme proteins.

Question 5

With the production of more steam in the sterilizer chamber,the pressure increases as well.The steam should contain little or no entrapped liquid water.Steam quality is the term that describes the amount of water mixed with the steam.The constitution of high-quality steam would be measured by:

A) 70% or greater.
B) 55% or greater.
C) less than 3% of the mixture is liquid water.
D) less than 1% of the mixture is liquid water.

Question 6

The Centers for Disease Control and Prevention (CDC)have identified pathogens that could pose a threat to national and world security and safety through bioterrorism.Select the four most probable agents that could be used to cause mass transmission,mortality,panic,and social disruption.

A) Anthrax, tuberculosis, Clostridium difficile, tularemia
B) Smallpox, plague, botulism, tularemia
C) Smallpox, monkeypox, avian influenza, anthrax
D) Anthrax, H1N₁ influenza, botulism, smallpox

Question 7

Which glove lubricant,used to facilitate easy donning,is considered a best practice?

A) Sterile talcum powder
B) Sterile corn starch powder
C) Sterile silicone powder
D) Nothing; glove lubricant is not recommended

Question 8

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins ______________ and _____________.

A) at the vagina and perineum; the nurse should check with the anesthesia provider before touching the patient
B) at the incision site to the periphery of the abdomen; only the nurse should begin and complete perioperative documentation of skin preparation, including wound classification
C) at the cleanest area first and proceeds to less clean areas (abdomen then vagina/perineum); a skin assessment should be performed
D) at the vagina and perineum first with urinary catheter insertion and then proceeds to the pelvic abdomen; a skin assessment should be performed

Question 9

To protect the forearms,hands,and clothing from contacting bacteria on the outside of the used gown and gloves,members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves.Which choice lists the appropriate first three steps in the removal of the sterile gown?

A) Wipe gloves clean, untie side gown closure, grasp gown at one shoulder seam
B) Wipe gloves clean, grasp gown at both shoulder seams, pull over and off arms
C) Unfasten gown back closures, grasp gown at one shoulder seam, pull down over both arms and gloves while everting glove cuffs
D) Grasp both gown shoulders, slide gown down over arms, grasp gloves inside gown sleeves and pull gown and gloves off together.

Question 10

Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?

A) Mask, gown, gloves, shoe covers
B) Gown, shoe covers, mask, gloves
C) Mask, gown, hat, gloves
D) Gown, gloves, mask

Question 11

A 47-year-old man was admitted to the emergency department (ED)with respiratory symptoms,facial and upper body abrasions,burns,and moist lesions after a small package,delivered to his office,exploded and sprayed him with dried powder and glass shards.In response to the reported mechanism of injury,the ED team sequestered him in a secluded area away from the rest of the patients.The team believed that this was highly suspicious of a bioterrorism event.The epidemiologist was called,and the patient was transferred to a negative-pressure isolation room and placed on standard,contact,airborne,and droplet precautions.Based on these actions,which microorganism agents might be suspected to be involved?

A) Plague and tuberculosis
B) Smallpox and tuberculosis
C) Ebola virus and monkeypox
D) Anthrax and smallpox

Question 12

The accumulation of dust,debris,and other microbial contaminants is a potential source of SSIs.Guidance for cleaning processes in the perioperative area states that perioperative staff should:

A) clean walls after every patient.
B) use enhanced cleaning procedures in the presence of multidrug-resistant organisms.
C) use alcohol to disinfect large environmental surfaces.
D) remove trash before the patient leaves the room.

Question 13

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations.However,disinfection differs from sterilization in that the process for disinfection uses:

A) contact precautions as well as universal precautions.
B) hospital-grade disinfectant/sterilants.
C) semi critical medical devices used for ambulatory procedures.
D) agents to disinfect and eliminate most, if not all, pathogenic microbes.

Question 14

Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however:

A) it can only be used for the initial gloving.
B) it requires two people to execute without contamination.
C) there is a risk of contamination if the thumbs are not extended.
D) it is only used when double gloving is anticipated.

Question 15

While antibiotics have been credited with saving lives,misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs).Select the antibiotic application that has evidence to support it as a best practice and not,potentially,a misuse of antibiotics.

A) Antibiotics should be administered 1 hour prior to surgical incision, within 2 hours for vancomycin or fluorquinolones for every procedure with an incision or entered body system.
B) Vancomycin paste applied to cut edges of the sternum in cardiac surgery.
C) Tobramycin and methylmethacrylate bead implants into deep orthopedic incisions at risk for osteomyelitis.
D) Bacitracin ointment on a clean subcuticular sutured incision as part of the dressing.

Question 16

Qualities of an effective packaging material must include several key characteristics.Select the three most important qualities.

A) Cost, good microbial barrier, lint-free writable surface
B) Good steam penetration and removal, good microbial barrier, resists tearing
C) Aseptic presentation, event-related sterility indicators, writable surface
D) Stackable in sterilizer/storage shelf, comparable cost, low toxicity

Question 17

The final step,after decontamination and before sterilization,is the prep,pack,and wrap process.The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization.Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.

A) Air-dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape
B) Inspect, unlock locked clamps, count and string instruments, place indicators, wrap and tape
C) Inspect, unlock locked clamps, string instruments, inventory, replace missing items, wrap
D) Inspect, inventory against list, assemble, place integrators, wrap and tape

Question 18

An integrator is a multiparameter indicator designed to measure:

A) time and pressure.
B) pressure, steam, and temperature.
C) temperature, time, and presence of steam.
D) sterility and pressure.

Question 19

Sterilization prepares instruments to be used within,and on,sterile tissues.It kills vegetative microorganisms and endospores within a probability of 10⁶.The process of decontamination prepares instruments to be:

A) handled without PPEs.
B) free of bioburden.
C) clean at a high level of disinfection.
D) Used on nonsterile ear, nose, and throat (ENT) procedures.

Question 20

The scrub person is preparing to self-don a wraparound sterile gown before surgery.Select the best practice to follow for the self-gowning procedure:

A) hold the gown away from the body and allow it to unfold with the outside toward the wearer.
B) keep hands on the outside of the gown as it completely unfolds.
C) slip one hand into an open armhole at a time, while using the other hand to hold the shoulder of the gown in place.
D) push the hands and forearms into the sleeves, advancing the hands just to the proximal edge of the cuff.

Question 21

The emergence of multidrug resistant organisms (MDROs)and C.difficile has posed a challenge in the management of surgical patients.Protocols to reduce the risk of transmission should include:

A) schedule patient as the first case of the day.
B) segregate the patient using contact precautions.
C) taping all cabinets shut.
D) clean and disinfect equipment as close as possible to time of use.
E) wear gown and gloves whenever there is a potential for contact with fluids.
F) limit patient transportation to essential movement only.

Question 22

When applying sterile drapes to create the sterile field on the patient,which of the following principles is most important?

A) Using careful movement to reposition the drape if needed
B) Shaking and fanning out the drapes gently to open up the folds before approaching the patient
C) Draping the patient starting with the incision area and proceeding to the periphery
D) Draping the far side first

Question 23

The American College of Surgeons and Surgical Infection Society released guideline for the prevention and treatment of surgical site infections (SSI)in 2016.Key measures include:

A) maintaining blood glucose at 110 to 150 mg/dL.
B) avoidance of alcohol containing skin preps.
C) use of double gloving.
D) administration of vancomycin in MRSA negative patients.
E) administration of prophylactic antibiotics 1 hour prior to surgical incision.

Question 24

In several studies,it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pairs of sterile surgical gloves,as opposed to wearing one pair.Select the correct statement that refers to double gloving in terms of a best practice.

A) The CDC endorses double gloving only when nonlatex gloves are worn.
B) Wearing two glove layers permits regloving using the closed-glove technique for a contaminated glove.
C) Wearing a glove liner between both layers of gloves may eliminate the risk of perforation to the inner glove, protecting the wearer from sharps injury.
D) Double gloving is the best practice that can protect both the healthcare provider and the patient.

Question 25

The surgical hand scrub is designed to:

A) remove transient microorganisms and suppress resident microorganisms.
B) target a narrow range of microorganisms.
C) work slowly and depend on cumulative action.
D) fully sterilize the skin on the hands and arms.

Question 26

Decontamination of the hands can be done by a variety of methods.Facility infection control procedures govern the selection of materials and the methods used for surgical hand hygiene.Select the best practice for surgical hand hygiene.

A) Use of an alcohol-based hand lotion.
B) Use of an anatomic scrub, with a prescribed number of strokes plus friction.
C) Use of a brush whose bristles are as stiff as can be tolerated by the skin.
D) Elimination of sponges which are no longer recommended for surgical hand hygiene because they have been linked to skin cell shedding.

Question 27

Which of the following choices reflects the appropriate order of four of the steps in preparing for the surgical hand scrub procedure?

A) Wash hands and wrists, remove jewelry, replace mask and eye protection, contain hair
B) Contain hair and earrings in hat, wash hands and clean under nails, place mask and eye protection, remove jewelry
C) Remove jewelry, contain hair, don fresh mask and eye protection, wash hands and forearms
D) Don fresh mask, contain hair, place eye protection, clean under nails

Question 28

If a sterile glove becomes contaminated during the procedure,the best practice for corrective action is:

A) regloving with open-glove or assistive glove technique.
B) regloving with closed-glove technique.
C) removing gown and gloves and regowning and regloving.
D) placing a new sterile glove over the contaminated glove.

Question 29

Effective instrument decontamination is dependent on a particular sequence designed to lower bioburden to the lowest level.What is the first step in processing a basic set of laparotomy instruments through decontamination?

A) Rinse with cold water.
B) Remove and discard all disposable sharps.
C) Wipe instruments with sterile water during surgical procedure.
D) Transport in closed container to decontamination area.

Question 30

Sterile surgical drapes are used to create the sterile field,protecting the patient from endogenous and exogenous sources of contamination.Which action is essential to maintaining the sterile field?

A) Providing barrier protection from microorganisms, fluid, and particulate matter
B) Limiting environmental impact and flammability
C) Ensuring a fiscally responsible cost/benefit ratio and reducing glare
D) Selecting drapes that do not exhibit "memory" folds