1. Infection Prevention and Control Q&A – APIC Greater NY January 21, 2015 NYULMC Infection Prevention and Control Department 263-5454 / 598-6767

2. Question 1 You have a patient admitted to a 4 bedded Step- Down Unit room with known MRSA in a diabetic foot wound getting active care. The patient also has Influenza A on admission. What patient would be appropriate to be placed next to this patient and why?

3. Answer 1 A) Another patient with MRSA and flu B) Another patient with MRSA and keep the curtain between the beds pulled C) Another flu patient D) Any patient E) Block the adjacent bed and discuss with the senior administrator who is worried about the lost revenue from the blocked bed and the backed up ICU wanting to move pts down a level of care

4. Question 2 A patient admitted to your BMT unit, who is neutropenic (ANC 0.0, WBC 0.0) is Influenza A+. Your BMT rooms are single rooms and positively pressured relative to the hallway. What do you do about the HVAC status for this patient or do you move the patient off the BMT unit?

5. Answer 2 A) Don’t worry. All the other BMT pts are in a positively pressured room B) Make the patient wear a mask at all times except for meds/eating and restrict from walking in the hall. C) Move the patient to a negatively pressured room D) Put a mobile HEPA air purifier in the room (or the anteroom if available) E) Mask all other BMT pts when they ambulate in the hall F) Ask Facilities to make the room neutral pressured

6. Question 3 A new mom is in a private room and is s/p C- section 2 days. The staff nurse calls to report that the patient has developed acute watery diarrhea. Testing shows she is C. difficile NAP1 Strain +. What do you do…for her and for the infant?

7. Answer 3 A) Nothing; infants do not get ill with C. difficile so there is nothing else to do. B) Contact Precautions for mom, keep the baby in the nursery 24/7 (no contact with mom). She can take the infant home when she is discharged. C) Contact Precautions for mom, keep the baby in the room 24/7 (baby can’t go to the unit). Mom has to wash her hands before holding the infant. D) Choice C + give the infant low dose oral vancomycin as prophylaxis against C. difficile.

8. Question 4 Surgical Services is concerned about an increase in the SSI rate for total hip replacement patients. You haven’t worked on this topic much so you would suggest which of the following SSI prevention strategies?

9. Answer 4 A) Verify antibiotics are given peri-operatively B) Review HVAC records to make sure the OR is positively pressured C) Start doing pre-op MRSA screening of all ortho patients D) Start doing post-op CHG bathing E) Eliminate all post-op antibiotics F) Check CSP’s sterilizer logs to make sure trays are sterilized properly G) Do observations in the OR to watch sterile technique & OR traffic issues H) Swab the surgeons and scrub nurses noses for MRSA carriage