By:Carmentina Silvestre-Tan, MS, BSN, RN Queens Hospital Center

1. The hospital is full and the IP is consulted concerning placement of a new admission. Which of the following patients are BEST candidates for cohorting? a. A new patient postoperative from a cholecystectomy and a patient with a decubitus ulcer that was debrided in surgery today b. A patient with AIDS and a patient receiving chemotherapy c. A new admission with influenza and a patient with pneumonia who was originally admitted with influenza 4 days ago d. A premature neonate and a full-term healthy baby, born this morning

2. When a patient with AIDS is admitted with possible pneumonia, the physician, who is a general practitioner, orders airborne isolation. What is the correct response? a. PCP is not transmitted person-to-person and does not require isolation. b. A TST test should be placed to determine if patient may have TB c. A sputum specimen should be collected for AFB daily x 3, if TB is suspected. d. If the chest radiograph is clear, isolation can be discontinued

3. You receive a call from a frantic nurse on the obstetric unit. She has patient who lived with a man who has just been diagnosed with active TB. She has just been tested by local DOH on her left forearm. There is a raised area in the position where you usually give PPD skin tests. It measures 12 mm across the diameter of the induration.  The nurse states that the young woman is in active labor and will probably have the baby within the next 2 hours. She states they do not have any isolation rooms on the labor/delivery unit. Your advice would be: a. Do nothing until the infant is born, then get a CXR. b. Question the mother regarding symptoms of TB and get a CXR after the baby is born. c. Move the mother to an isolation room with negative pressure, wear N95 respirators, and place a trained labor room nurse with her. d. Place a surgical mask on the mother until after childbirth, when a CXR can be obtained.

4. BONUS QUESTION! Your OR policy states, in accord with current AORN standards, that shoe covers are not required all the time. The policy states that shoe covers are worn if the staff member anticipates possible blood exposure due to the nature of the case being done and when shoes are dirty. (so far, so good, right?) During an OR site visit, you notice a staff member leaving an OR room down the hall ahead of you leaving a spot of blood from her shoes on the hallway floor. Your responses should include: a. Ignore it – this hardly ever happens and the hall gets mopped now and then anyway. b. Stop the staff member, point out the problem, have her clean her shoe with a bleach wipe. c. Update the policy: “everyone must always wear shoe covers.” d. Update the policy: add a direct statement that states “if shoes do become visibly soiled, they must be cleaned with a bleach wipe before leaving the OR room and, if shoe covers are worn and the shoe covers become soiled, they must be removed before leaving the OR room.” e. What else???

Source: APIC Infection Prevention Competency Review Guide 4 th edition- Carol McLay