GREATER NY APIC CHAPTER MEETING – Q & A JUNE 21, 2017

CVC inserted at time of surgery on 1/8. QUESTION 1 Nursing Home patient admitted on 1/8 to MICU with hip fracture and Stage IV decubitus ulcer. CVC inserted at time of surgery on 1/8. Blood cultures positive for VRE on 1/21, 1/25 and 1/27 Pressure injury positive for VRE by swab on 2/1 Is the blood culture Secondary to the decubitus ulcer? Primary BSI (CLABSI)? Unclear source?

ANSWER B. CLABSI Rationale: 1. Wound culture fell outside the 7-day infection window period. The wound specimen collection method did not meet DECUB criteria which are organism(s) identified from needle aspiration of fluid or biopsy of tissue from ulcer margin

QUESTION 2 Guidelines for transporting specimens include: Transport within 2 hours of collecting a specimen. Transport in leakproof specimen contains and sealable leakproof bags. Transport specimen in the syringe used to collect it. Refrigerate all specimens prior to transport Choices: 1, 4 2, 3 1, 2 3, 4

Answer: C - 1, 2 Rationale: The appropriate selection, collection and transport of specimens are essential to the accurate identification of organisms All specimens must be transported within 2 hrs. of collection Leakproof transport containers are required (OSHA BBPS) Of note: never refrigerate spinal fluid, genital, eye or inner ear cultures as organisms from these sites may be sensitive to temperature extremes

Question 3 The ED reports 3 cases of cramping abdominal pain and diarrhea within a 24-hour period. All patients were from the same community and onset of symptoms was within 12-36 hours of a picnic. Which of the following foodborne illnesses is the most likely source? Hepatitis A Salmonella Clostridium perfringens Staph aureus

Answer: B - Salmonella Rationale: Onset of Salmonella food poisoning occurs with 12-72 hours and includes fever, diarrhea and abdominal cramps Staphylococcus toxins are fast-acting. Symptoms usually develop within 30 minutes to 6 hours. Patients typically experience vomiting, nausea, stomach cramps and diarrhea but no fever. C. perfringens food poisoning causes diarrhea and abdominal cramps within 6 to 24 hours (typically 8 to 12 hours). The illness usually begins suddenly and lasts for less than 24 hours. Hepatitis A symptoms usually appear anywhere from 2 to 6 weeks after exposure. Symptoms usually develop over a period of several days and include the above plus symptoms of liver inflammation.

Question 4 Which of the following patients is not at high risk for a healthcare-associated healthcare infection? Burn patient Premature baby in the NICU Bone marrow transplant patient Patient who underwent joint replacement surgery

Answer: D - Joint Replacement Surgery Rationale: Fungi are increasingly being identified as HA pathogens. Patients at high risk for HA fungal infections include patients with leukemia, solid tumors and leukopenia, bone marrow transplant patients, burn patients and premature or LBW infants.

Question 5 According to the CDC, which type of thermometer should be used in a vaccine storage unit? Fluid-filled biosafe liquid thermometer Chart recorder Infrared thermometer Probe in a glycol-filled bottle with an external monitoring device

Answer: D Probe in a glycol-filled bottle with an external monitoring device Rationale: This type of device allows for temperatures to be monitored without having to open the refrigerator door

Question 6 During infection prevention rounds, the IP discovers a small bucket filled with liquid inside the EVS cart. The service worker stated that she usually pours the cleaning solution into the bucket rather than directly from the product’s container. The IP States that this practice is acceptable. Explains that the cleaning solution container must be labeled with the chemical content, name and expiration date. C. Talks to the EVS manager and ask that she implement corrective action D. Explains that this is OK as long as the worker writes the name of the product on the bucket.

Answer: B Explains that the cleaning solution container must be labeled with the chemical content, name and expiration date. Rationale: Containers for cleaning agents must be labeled in accordance with regulatory requirements (e.g. chemical content, name and expiration date).

Question 7 The OR reports an infestation of fruit flies in the sterile instrument storage room. The sterile packs were temporarily removed for pest management. The OR staff asked if they can use these sterile packs. The IP answers: The packs can be used without reprocessing because there are no visible flies on the outside of the packs. OK to use because a test pack was opened and no flies were found. All items in the room need to be reprocessed. No need to repack the items but the packs must be run through the sterilizer again.

Answer: C All packs in the room need to be reprocessed. Rationale: Presence of any type of vermin can affect the integrity of the packaging and contaminate the contents. Fruit flies are small enough to crawl into the sterile packs and potentially contaminate the instruments. They can also become trapped in the packs and leave debris on the instruments.

Question 8 The nurse manager of the Rehab Unit is insisting on having aerators installed on the faucets in patient rooms. She is counseled that Low-flow aerators are suitable for use with this population. Aerators are more effective when combined with a UV disinfection method. Aerators should be placed on all sinks in the ICU only. Aerators increase the risk of HAIs.

Answer: D Aerators increase the risk of HAIs. Rationale: Aerators can promote the growth of water-associated pathogens. Faucet aerators can enhance growth of waterborne organisms. If they must be used, a systematic leaning system should be established.

Question 9 The Facilities director reports that the hot water tanks and distal sites were positive for Legionella. Disinfection of the hospital’s water system should be performed if: As a preventative measure even if prospective surveillance of HA legionellosis shows no cases. The colonization rate for distal water sites is greater than 30 percent. Recommended by hospital administration or risk management. D. As a pre-emptive measure even if no HA cases have been identified.

Answer: B The colonization rate for distal water sites is greater than 30 percent. Rationale: Disinfection of the water system should be considered if There is greater than 30% colonization of distal water sites There is evidence of a prior case, or Prospective surveillance shows a HA case