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Infection
Prevention and Control Practice Questions Forum
To ask a Practice Question E-mail, steve.osterholt@crbard.com and question will go out to all APIC Chapter 26 members. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice question from Rebeckah Williams, this is one of those classic infection prevention principles vs. regulations - In a skilled nursing facility if a patient is admitted and the 1st PPD is administered ….but the patient acutes out but is readmitted within 21 days - will ODH/CMS acknowledge the 1st original PPD from the 1st separate admission allowing us to just administer a 2nd - or do they require that you start over since it is a separate/2nd admission? Hope that made sense - please feel free to call will any questions. Thanks , Bec P.S. So far I have not been able to get a consensus on this issue - but from strictly an IP standpoint the 1 PPD should count. Thanks, Bec Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question from Cheryl Marischen Our lab person says that glucometers only need to be cleaned weekly and nursing says after every use. What are other facilities doing? Thank you, Cheryl Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question; What cleaning products are hospitals using to clean and disinfect equipment? How are hospitals informing employees on what product to use for equipment, who is responsible for cleaning equipment and how often to clean equipment? Thank you, Libby (Elizabeth) Singhoffer Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question; Does your hospital allow visitors to eat in patient rooms? Any restrictions for ICU rooms? Isolation rooms? I would think it would be prohibited in C. diff rooms –especially due to oral-fecal route transmission and widespread contamination, other isolation rooms since your visitors may be wearing isolation garb: gloves/gowns/ masks. Any comments will be appreciated . Thanks, Mary Nicholson RN Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question; Because of some of the responses I received I wanted to clarify that I was asking about tourniquet usage in the OR for extremity cases, not tourniquets used for IV starts. I appreciate all the responses I received but would like to know if the answer is different for this type of tourniquet. Thanks so much. Judith Cook, RNFA, BSN, CNOR Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question; I have a couple of questions pertaining to the Tdap vaccine: 1) Is it available for use in the ER or Urgent Care setting? How about inpatient OB after delivery? 2) If it is available for use, it is routinely used in place of Td if not previously vaccinated with Tdap? Thank you in advance for your responses! Nicole Pleiman Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PRACTICE QUESTION from Pam McCartney, What do you do with the CRASH CART contents after a code when the crash cart had to be taken into an isolation room? Thank you, Pam Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Do you allow your OR staff to scrub and participate in surgeries if they have breaks in the skin on their hands (abrasions, cuts, sutures, etc.)? If so, how do they scrub (scrub then cover with Tegaderm, Tegaderm then scrub remainder of hand, no covering, etc.)? Thanks, Shannon Drake. Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice question from Vicki Johnson, What type of respiratory protection is staff using in the OR while caring for a patient in airborne isolation? Thanks, Vicki Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question from Kathy Zegarski, Does anyone have a policy on flowers for their facility they are willing to share? Thanks Kathy . Click Here to review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question February 2010 Current practice in Preop is to spike IV bags with tubing and date to be discarded if not used in 24 hours. These are kept in a secure location. We based this on our hang time policy of not to exceed 96 hours although hardly anyone has keep open IVs any more. In order to help maintain normothermia during surgery the Preop area suggested placing these spiked IV bags in a fluid warmer? What are your thoughts on this? Terry Accuntius Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question February 2010 Has anyone which out their whole facility to disposable cuffs only? And if so what supportive data do you use to do so? from Linda S. Smith. Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question February 2010 We are looking to see what type of cleaning/disinfecting agents other facilities are using (e.g., quat, phenolic, bleach, etc). I am breaking this into 2 questions 1. What types of cleaning/disinfecting products are your facilities using? 2. In what areas/departments are they used? 3. On what surfaces (floors, beds, equipment, etc) are they used? Thanks everyone in advance! from Kathy Zegarski Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question February 2010 Would you mind asking the group for pre-op
site marking do they:
1. Use a new marker with each patient?
2. If not, do they use a separate site marker if the
patient is in isolation or have record
flagged for MRSA, VRE, C diff, open wound?
3. If not, does anyone wipe off the marker between
patients?
Thanks, Mary Nicholson,
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~1/6/10 Practice Question: We were wondering – without the presence of 3 negative stool specimens to rule out colonization how long would a person be tracked and isolated for a history of VRE with no further infections ever noted. Would you still be tracking them and isolating after 7years? 10 years? 20 years? Thanks! Samuel Kader RN, BSN, MA, Infection Prevention & Control, Grandview/Southview Click here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Question, September 30, 2009 Who is responsible for cleaning computers in your facilities? If the cleaning is divided, how is it divided? Also, how often are they cleaned? Kathy Zegarski BS, CIC Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Practice Questions: Practice question from Holly Freeman at Jewish Hospital The floor nurses sometimes do not see visitors going into isolation rooms without protection.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ September 2, 2009; What are your practices related to the reuse of MDI(multi-dose inhalers) or canisters? How do you disinfect the canister prior to issuing to another patient. Have you experience any negative outcomes? Comments? Azalea Wedig Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ August 3, 2009 Practice Question: when are other facilities going to start administering the seasonal flu vaccine to employees? CDC/ACIP is recommending as soon as possible. Mandy Platt RN Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ July 14, 2009 Terry Accunties Practice Question; 1. If your facility uses pass through draws (pharmacy delivers meds via locked drawer outside the room and nurse accesses locked drawer from inside the room) for medication and other supplies what is your process for cleaning and dealing with left over medications and supplies? 2. Is it any different for patients on isolation precautions? 3. How do you instruct nurses to enter the drawer for patients in isolation? a. Would they use gloves they may have used while in direct contact with the patient? b. How would you ensure that only clean hands and clean gloves could be used? Click Here to Review Respones ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6/26/2009 Practice Questions from Kathy Zegarski;
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5/29/2009 Practice Question from Nicole Pleiman We have a surgeon who will not use the Central Line Bundles when inserting a line on the nursing unit. * What do you do for physician noncompliance? * What do you require of your nurses who are in the room or whomever could possibly assist the physician placing the line? * Maximum Barrier Precautions? * The last thing is do you use the small drape included in the barrier pack or a large patient drape? Click Here to Review Responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Date: 4/30/2009 1. What type of surgical head covering does your OR staff and surgeons wear? 2. Do you have a policy which only permits certain head coverings? 3. Is it different for your staff versus the surgeons? Bouffant cap? Surgeons cap ( cover’s top of the head)? Anything else? Thanks, Mary Nicholson Click Here to Review Responses ------------------------------------------------------------------------------------------- 4/16/2009 I recently initiated a central line checklist at our facility. I am getting some pushback from our OR department. If your facility has a central line checklist in place how are you handling any similar issues? Here is an example of what I’m hearing: Surgery is "always" a sterile environment, "why do we need to complete a checklist about washing hands, using maximum barriers and properly prepping the patient etc"? "We do this all the time” This is a response I am getting from a lot of staff in our OR. Another question I have is Dialysis catheters…We place a good number of these in our OR. Is anyone including these in the checklist at your facility? Thanks! Mandy Platt RN Click here to review responses ------------------------------------------------------------------------------------------- 4/2/2009 Re: pregnant employees and isolation rooms. Does anyone allow work restrictions for any type of isolation with pregnant employee? If so what diseases? If not, do you have a policy statement to support pregnant employees caring for isolation pts? What do you use for reference? APIC text states: if standard precautions are used, restriction of pt care rarely indicated. The gray zone I am concerned about is acceptance of + Varicella hx, no titer, for evidence of immunity when hiring employees (we still accept this at this time (I know HICPAC is voting on proposal in June on dropping physician dx and/or DOB before 1957 for MMR issues in June, but I am not aware the Varicella issue is changed). And finally if you require actual titers on new hires for these diseases, what did you do with previous hires not titered? We have one nursing unit, night shift with the majority pregnant...ugh?! Linda S. Smith, RN, BSN, CIC Click here to review responses ------------------------------------------------------------------------------------------- March 23, 2009, How are other facilities handling drinks at the nurse’s station or work areas? Are there certain areas where they are allowed? Are there any standards or guidelines addressing this issue? Thanks! Mandy Platt. Click here to review responses ------------------------------------------------------------------------------------------- March 20, 2009, I have a question regarding MRSA screening. If you place the positive (colonized, not infected) patients in Contact Precautions, do you keep them in isolation throughout their admission or are you removing them from isolation after they have completed the Mupirocin treatment? Thank you. Nancy Raffel, RN Click here to review responses ------------------------------------------------------------------------------------------- March 20, 2009, Is there anyone who routinely gives Tdap vaccine to adults in your facility? Who gets it? Do you include Emergency room patients? Do you give all new hires based on documentation or their word? Eulin Kuranga, MT (ASCP)SM, MPH,CIC Click here to review responses ------------------------------------------------------------------------------------------- March 16, 2009, Are your hospitals seeing a significant rise in C-diff cases? Practice question from Azalea Wedig, BS, IP. Click here to review responses ------------------------------------------------------------------------------------------- March 16, 2009, I have some questions that I would love help on. I work in an outpatient oncology office and we are seeing patients with beds bugs. Can I get input on: 1) Management of the patient with bed bugs in an inpatient and outpatient setting 2) Staff education/protection against infestation of bed bugs from care of a patient 3) Cleaning for outpatient areas to avoid further infestation (other patients), what products are used. 4) Precautions used by staff when treating a patient with bed bugs 5) Any guidelines about patients need to demonstrate “personal” clean up before coming back for care. I’ve been to the Cincinnati Department of Heaths website and watched their videos as well as other sites for information but an curious as to what other clinics are doing. Practice question from Brandie Weber RN. Click here to review responses ------------------------------------------------------------------------------------------- March 6, 2009, I would like to know if any of you are thinking about going to coffee mugs and containers to be “purchased” reusable by employees and they can get refills in the cafeteria. This will eliminate the Styrofoam cups and Styrofoam containers for soft drinks. The employee would have to be trusted to wash their purchased cup or container. No guarantees it will happen but there are ways that the lip of the container would never touch the parts of the coffee or soft drink dispenser. What do you think? I have been asked to cast my vote for or against this and I told them I would see what others were doing. Pam McCartney, RN, BSN Click here to review responses. ------------------------------------------------------------------------------------------- February 3, 2009 Our OB dept has a "rule" that says any child who has rec'd a vaccine w/in the last 30 days can not visit this dept. No one seems to know why we have this other than they may have gotten these rule from MVH NICU. We do not "house" high risk infants in our community hospital. Do other facilites have this same rule? I don't see it in ODH regs and our local health dept was not familiar. Linda S. Smith, RN, BSN, CIC Click Here to review responses. ------------------------------------------------------------------------------------------- Practice question January 30, 2009, from Jane Mescher, How frequently does your facility change regular IV tubing - intermittent IV tubing? Click here to review responses. Practice Question from Jane Mescher, January 26, 2009. What form of hair removal does your facility use for a hairy chest prior to applying patches? Click here to review responses. ------------------------------------------------------------------------------------------- Practice question from Maria Grega Jan. 26, 2009. 1). In a hemodialysis facility that has Hepatitis B positive patients, who are dialyzed in an isolated "area" and are in a row, partial wall with open fronts to the areas, would it be acceptable to consider these patients as being co-horted, therefore staff caring for them can wear one isolation gown for all three patients instead of an individual gown for each patient. 2). In the HBV+ isolation area, could staff use specific "goggles" for eye protection, that stay in the isolation area, as designated isolation equipment? Click here to review responses. ------------------------------------------------------------------------------------------- Jane Carmean,s practice question January 20, 2009, In your facility, does a healthcare worker who wears cotton glove liners (due to allergies, etc.), remove the cotton gloves and complete hand hygiene each time exam gloves are removed? Click here to review review responses A. Click here to review review responses B. -------------------------------------------------------------------------------------------- Mary Nicholson's practice question January 6, 2009. For B&BF exposures which occur during non employee health office hours …. What is your process for obtaining an HIV consent obtained on source patients? Who is responsible for obtaining the consent so that the rapid HIV testing may be completed? Click here to review responses. ------------------------------------------------------------------------------------------- |