APIC Greater NY Chapter 13 Q&A Session October 19th 2016 Presented by: Carmel Boland-Reardon, RN CIC Infection Preventionist

Question #1 The IP is teaching nurses how to assess infection risks in patients. Depletion of what cell type provides the best indication of susceptibility to most bacterial infections? Monocyte Eosinophil Neutrophil Lymphocyte

Answer # 1 The IP is teaching nurses how to assess infection risks in patients. Depletion of what cell type provides the best indication of susceptibility to most bacterial infections? Monocyte Eosinophil Neutrophil Lymphocyte

Answer # 1 Cont’d C. - Neutrophil Rationale: Neutrophils are the most abundant (40 to 75 percent) type of white blood cell and are formed from stem cells in the bone marrow. They are short lived and highly motile. Neutrophils may be subdivided into segmented neutrophils (or segs) and banded neutrophils (or bands). They form part of the polymorphonuclear cell family together with basophils and eosinophils. Neutropenia is a granulocyte disorder characterized by an abnormally low number of neutrophils. Neutrophils usually make up 50 to 70 percent of circulating white blood cells and serve as the primary defense against infections. Reference: APIC Text 4th edition, Chapter 22 – Microbial Pathogenicity and Host Response. CBIC Core Competency: Identification of Infectious Disease Processes.

Question # 2 What is the name given to an aggregation of cases in a given area over a particular period without regard to whether the number of cases is more that expected? Pseudo–outbreak Outbreak Cluster Epidemic

Answer # 2 What is the name given to an aggregation of cases in a given area over a particular period without regard to whether the number of cases is more that expected? Pseudo–outbreak Outbreak Cluster Epidemic

Answer # 2 Cont’d C. Cluster Rationale: Epidemics or outbreaks are defined as an increase over the expected occurrence of an event. Given that definition, it is important to note that a single case of an unusual disease may constitute an outbreak. In contrast to outbreak and epidemic, a cluster is an aggregation of cases in a given area over a particular period without regard to whether the number of cases is more that expected. Outbreaks and clusters both require prompt investigation. Reference: APIC Text, 4th edition, Chapter 12 – Outbreak Investigations. CBIC Core Competency: Surveillance and Epidemiologic Investigation.

Question # 3 The Hemodialysis Department at a hospital completes a monthly water culture testing. The results are over the limit for colony-forming unit (CFU) per ml. Which of the following actions should be done first? Notify the physician Initiate daily water culture testing Disinfect the system Notify the Infection Control Department

Answer # 3 The Hemodialysis Department at a hospital completes a monthly water culture testing. The results are over the limit for colony-forming unit (CFU) per ml. Which of the following actions should be done first? Notify the physician Initiate daily water culture testing Disinfect the system Notify the Infection Control Department

Question # 3 Cont’d C. Disinfect the system Rationale: According to the Conditions for Coverage document from Centers for Medicare & Medicaid Services ( CMS), product water used to prepare dialysate or concentrates from powder at a dialysis facility, or to process dialyzers for reuse, shall contain a total viable microbial count lower that 200 CFU/ml and an endotoxin concentration lower that 2 EU/ml. Measures must be performed promptly when results exceed the action level or the maximum allowable level. Dialysis may continue when bacteria/endotoxin is found to be at the action level, but retesting and/or disinfection of the system should be performed promptly. Promptly has been defined by CMS regulation as within 48 hours of receiving the report. Reference: APIC Text, 4th edition, Chapter 39 – Dialysis. CBIC Core Competency: Preventing / Controlling the Transmission of Infectious Agents.

Question # 4 Unused alcohol swabs that are placed on top of a dialysis machine in an active dialysis unit: Should be discarded May be returned to the common area Must be cleaned before being used on another patient Should only be used on patients with that dialysis machine

Answer # 4 Unused alcohol swabs that are placed on top of a dialysis machine in an active dialysis unit: Should be discarded May be returned to the common area Must be cleaned before being used on another patient Should only be used on patients with that dialysis machine

Answer # 4 Cont’d Should be discarded Rationale: There have been transmission of Hepatitis B and Hepatitis C in dialysis settings, which necessitates rigorous infection control practices. Any medications or patient care supplies such as tape, alcohol swabs, and syringes that come in contact with a dialysis machine should be discarded. Other items should be cleaned if possible before being returned to a common area or used on another patient. If cleaning is not possible, then those items should also be discarded. Reference: APIC Text, 4th edition, Chapter 39 – Dialysis. CBIC Core Competency: Cleaning, Sterilization, Disinfection, Asepsis.

Question # 5 A nurse manager from a Rehabilitation Unit is requesting that aerators be installed on the sinks in the patient rooms on her unit. The IP should explain that: Aerators should be placed on all sinks in the ICU only Aerators are more effective when combined with an ultraviolet water disinfection method Aerators increase the risk of HAI’s Low–flow aerators are suitable for use with this population

Answer # 5 A nurse manager from a Rehabilitation Unit is requesting that aerators be installed on the sinks in the patient rooms on her unit. The IP should explain that: Aerators should be placed on all sinks in the ICU only Aerators are more effective when combined with an ultraviolet water disinfection method Aerators increase the risk of HAI’s Low–flow aerators are suitable for use with this population

Answer # 5 Cont’d C. Aerators increase the risk of HAI’s Rationale: Various types of equipment and fixtures can promote the growth of water–associated pathogens, Important water reservoirs for these organisms include potable water systems and cooling towers, flush sinks, faucet aerators, hoppers and toilets, eyewash/drench shower stations, chests/ice machines, water baths used to thaw or warm blood products and other liquids and whirlpool or spa-like baths. Faucet aerators on sinks can enhance growth of water borne organisms. Aerators are not recommended, but if they must be used, especially in an area with immunocompromised patients, a systematic cleaning routine should be established. Reference: APIC Text, 4th edition, Chapter 115 – Water Systems issues and Prevention of Waterborne Infectious Diseases in Healthcare Facilities. CBIC Core Competency: Environment of Care.

Thank you