Infection Control

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  1. Hand hygiene is to be performed upon entering the patient treatment area, prior/removal to _____, after contamination with blood or other infectious material, after patient and dialysis _____ contact, between patients even if the contact is ____, before touching clean areas such as supplies and on exiting the ______ area.
    • Gloving
    • Delivery system
    • Casual
    • Patient treatment
  2. If hands are not visibly contaminated, use of an ______ may be substituted for handwashing
    Alcohol-based hand rub
  3. The alcohol content of hand rub solution must be __%- __% ethyl alcohol, isopropylalcohol, or a combination of both.
    60% - 95%
  4. Per the CDC, there is no limit on the number of times alcohol-based hand rubs may be used unless hands are _____.
    Visibly contaminated
  5. Alcohol-based hand rubs may be used:

    Name 3 situations
    • In the absence of sinks/water
    • In the event of an emergency
    • Before gloving and after glove removal
  6. It is a requirement for all DaVita teammates whose primary location is working in afacility to have only ____ nails.
  7. Facial contact of any sorts (includes eating or touching face with item) is prohibited on patient floor.

    T or F
    • True
    • Teammates will keep fingers, pens, pencils, labels, etc., away from mouth. Eating,drinking, smoking, applying cosmetics or lip balm, and handling of contact lenses isprohibited in the patient care and reuse areas.
  8. Fingernail length should not extend more than ___ inch.
  9. Define traditional nail polish.
    Traditional nail polish is polishthat can be removed easily with a cotton ball and nail polish remover. Removal of traditional nail polish does not require soaking the nail or mechanical filing for removal of the polish. Traditional nail polish is free of sparkles and any type of raised or cracked texture
  10. Teammates will wear ____ when caring for the patient or touching the patient's equipment at the dialysis station, and will remove gloves and wash hands orperform hand hygiene between each patient and/or station.
    Disposable gloves
  11. Gloves should be changed when:
    -Soiled with ____, ____, or other bodily fluids
    -Going from a "dirty" area or task to a ____ area or task.
    -Moving from a contaminated body site to a ___ site.
    -After touching one patient or their equipment and before _____.
    • Blood
    • Dialysate
    • Clean
    • Clean
    • Arriving to care for another patient or touch another patient's equipment.
  12. Gloves should be provided to patients and gloves and ___to visitors if these individuals assist with procedures such as ____. If patient does not want to wear gloves, patient should be re-educated on the need for wearing gloves. Re-education is to be documented in patient’s _____. If patient continues to refuse to wear gloves, the teammate must hold the patient’s sites or use vascular access clamps if ordered by the ____.
    • Gown
    • Self-cannulation or holding access sites.
    • Medical Record
    • Physician
  13. What date do you check for before opening any package?
  14. Medication vials, syringes, tape, alcohol swabs, gloves or other supplies will not becarried in ____.
  15. Patients are encouraged to wash their ____ and ____ upon entering the treatment area prior to the initiation of dialysis and wash their hands after treatment before leaving treatment area.
    • Hands
    • Access extremity
  16. Dressing changes should not be performed in the treatment area with the exception of ____ care.
    Vascular access
  17. External venous and arterial pressure transducer protectors, if present, are to be used for each patient treatment to prevent ____ of the dialysis delivery systems pressure monitors. External transducer protectors are ___ use and discarded after each patient treatment. Internal transducer protectors ___ need to be changed routinely between patients.
    • Contamination
    • Single
    • Do not
  18. Unused medications, (including multiple dose vials containing diluents) or supplies(syringes, alcohol swabs, tape, etc.) taken to the patient's station should be used only for ____ and should not be returned to a common clean area.
    That patient
  19. Teammates will not store extra dialysis supplies, for example, saline and blood lines, on ____ near patient stations where contamination of such supplies could possibly occur.
  20. After all visible blood is cleaned with the 1:10 (one to ten)bleach solution, teammates are to use ____ soaked with 1:10 (one to ten) bleach solution and clean area a second time.
    a new disposable towel
  21. The dialysis delivery system will be disinfected after a confirmed blood leak and prior to next patient use, in addition to normal daily disinfection practices.

    For B Braun dialysis delivery systems – _____ disinfection
    Thermal citric
  22. ___ may be used on chairs and beds and be changed between each patient
    Protective covering
  23. All containers used to soak clamps, or other non disposable equipment will be cleaned and disinfected at the ____, or immediately after _____.
    • Conclusion of the day
    • Visible contamination
  24. Use of battery operated, electrical or ceiling mounted fans are _____ in patient treatment areas.
    not allowed
  25. The ChairSideSnappy cart, monitor and keyboard are considered ____ areas.
  26. .The ChairSideSnappy cart, keyboard cover and plastic surfaces of the monitor will becleaned with a disposable wipe moistened with a 1:100 (one to one hundred) bleach solution at the ___ of each treatment day.
  27. Using the appropriate amount of hand rub product maximizes effectiveness of hand rub as per _____.
    Manufacturer recommendations
  28. Hand wash for ____ seconds. Minimum
  29. In order to prevent the transmission of Hepatitis B among patients, all new patientsshould be tested and their HBV serologic status (i.e., Hepatitis B Surface antigen[HBsAg], Total Hepatitis B Core Antibody [total anti-HBc or HBcAb], and Hepatitis BSurface Antibody [anti-HBs or HBsAb]) results should be known prior to first treatment,unless otherwise required by applicable State law.
  30. Hepatitis Surveillance

    If the results of this testing are notknown and the Medical Director determines that the patient needs to be admitted fortreatment before prior testing can be completed, then the patient should be testedimmediately upon intake and results known within ____ days of admission.
    seven (7)
  31. Hepatitis Surveillance

    Documentation of current laboratory values will be accepted for a patient transferring in from another _____
     Hepatitis B surface antigen results drawn within ____ to first treatment date OR positive hepatitis B surface antibody results drawn within ____ of first treatment date will be accepted
       If a patient has received the hepatitis vaccination series, a copy of the vaccination record should also be included
    • dialysis facility
    • 30 days prior
    • one (1) year

    If the hepatitis B surface antigen (HBsAg) status is unknown

    -Reuse will not be instituted until documentation is available indicating the patient is hepatitis B surface antigen (HBsAg) ___.
    -The facility ____ will be made aware of pending admissions for all hepatitisB surface antigen (HBsAg) positive patients.
    -Documentation of hepatitis B surface antibodies (HBsAb or anti-HBs) and the hepatitis B total core antibody (total anti-HBc or HBcAb) will remain in the patient’s current active medical record.
    • negative
    • Medical Director
  33. ____ hepatitis B surface antigen (HBsAg) testing will be completed on patients who are susceptible or not immune to hepatitis B infection, including _____ to thevaccine.
    • Monthly
    • non-responders
  34. ____ hepatitis B surface antibody (HBsAb or anti-HBs) testing will be completed on patients who are both hepatitis B surface antibody positive (> 10 mIU/mL) and total hepatitis B core antibody (total anti-HBc or HBcAb) negative.
  35. _____ additional hepatitis B testing is required on patients who are hepatitis B surfaceantigen (HBsAg) negative and are positive for both the hepatitis B surface antibody(HBsAb or anti-HBs) and the total hepatitis B core antibody (total anti-HBc or HBcAb),indicating lasting acquired immunity.
  36. Any guest patient (DaVita or non-DaVita) must provide documentation of a negative ___ HBsAg within ____ prior to first treatment date OR positive HBsAb results within ____ of first treatment date.
    • monthly
    • 30 days
    • one (1) year
  37. If initial testing indicates the patient is total hepatitis B core antibody (total anti-HBc orHBcAb), positive and hepatitis B surface antigen (HBsAg) negative and hepatitis Bsurface antibody (HBsAb or anti-HBs) negative, draw a blood sample and send for a____total hepatitis B core antibody.
  38. If the total hepatitis B core antibody is _____, consider the patient susceptible,and vaccinate against hepatitis B per policy.
  39. If the total hepatitis B core antibody is positive, draw a specimen for the _____  of the hepatitis B core antibody (IgM anti-HBc).
    immunoglobulin IgM class
  40. If the immunoglobulin IgM class of the hepatitis B core antibody is _____, vaccinate against hepatitis B per policy.
    • Negative
    • *****If the hepatitis B surface antibody is < 10 mIU/mL even after twofull vaccine series, test for the presence of hepatitis B nucleic acid(HBV DNA)
    • *****If the hepatitis B nucleic acid (HBV DNA) is negative, consider thepatient susceptible, (i.e., the total hepatitis B core antibody is a falsepositive), and test monthly for hepatitis B surface antigen
    • ******If the hepatitis B nucleic acid (HBV DNA) is positive, consider thepatient as past infection or low-level chronic infection. Isolation isnot necessary because the hepatitis B surface antigen is notdetectable
  41. If both the total hepatitis B core antibody and the immunoglobulin IgM class of the hepatitis B core antibody are positive, consider the patient _____.
    recently infected
  42. If both the total hepatitis B core antibody and the immunoglobulin IgM class of the hepatitis B core antibody are positive, consider the patient recently infected.

    -Test for Hepatitis B surface antibody in __ to __ months 
    -Isolations ___ necessary.
    -Continue to test monthly for the hepatitis B surface antigen as long as the surface antigen remains ____ and the hepatitis B surface antibody is negative
    • 4
    • 6
    • Is not
    • Neg.
  43. If initial or monthly testing indicates the patient is hepatitis B surface antigen (HBsAg)positive, the patient will be considered _____ and cared for using ______described in policy
    • potentially infectious
    • Isolation measures
  44. If after repeat testing, the initial surface antigen result was found to be a true positive and not related to vaccine induced transient antigenemia (antigen testing within 30 days of vaccination may result in a false positive result), test for the _____  and the _____  two(2) months later per physician order 

    ___ months later, repeat hepatitis B surface antigen and hepatitis B surface antibody testing per physician order
    A patient who remains hepatitis B core antibody positive and hepatitis B surface antigen positive at the end of six (6) months, will be considered a ____.
    • Total hepatitis B core antibody (total anti-HBc or HBcAb)
    • Immunoglobulin IgM class of the hepatitis B core antibody (IgM anti-HBc)
    • Six (6)
    • Chronic HBVcarrier
  45. If a patient converts from a negative hepatitis B surface antigen (HBsAg) status to a confirmed positive hepatitis B surface antigen status, investigate _____  including review of the patient’s recent medical history
    possible sources for infection
  46. Hepatitis B vaccination is recommended for all susceptible chronic dialysis patients and should be offered upon ____ with physician order.
  47. If an adult chronic kidney disease (CKD) patient begins the vaccine series with a standard dose prior to initiating dialysis therapy, then moves to hemodialysis before completing the series, complete the series using the ____ dose recommended for hemodialysis patients.
  48. If the vaccination series is interrupted after the first dose, the second dose should be administered as ____. The second and third dose should be separated by an interval of at least ____, while making effort to maintain the recommended vaccine specific dosing intervals.

    If using a four dose series, the fourth dose is to be given ____ after the initial dose. If only the fourth dose is delayed, it should be administered when convenient.
    • soon as possible
    • one (1) month
    • six (6) months
  49. Test all vaccinated patients for HBsAb __ to ___months after the last dose of thefull vaccine series (adequate response is defined as > 10 mIU/mL).
    • 1
    • 2
  50. If the hepatitis B surface antibody (HBsAb or anti-HBs) is > 10mIU/mL, consider patient ____, and retest ___ for HBsAb.
    • immune
    • annually

    -Isolation of HCV positive patients is ____.
    -HCV positive patients ___ participate in the dialyzer reuse program.
    -Anti-HCV will be obtained with physician order and medical justification
    • not necessary
    • may
  52. Hepatitis D is found only in patients with chronic HBsAg infection and routine surveillance testing is ____ .
    not necessary and not recommended
  53. If a patient is known to be infected with HDV, or there appears to be evidence of transmission of HDV in a dialysis facility, screening for delta antibody may be warranted and should be performed only per ___ and ___.
    physician order and medical justification
  54. Patients who are known to be infected with HDV will be separated from other dialysis patients, including those who are ____ patients would be at risk of acquiring a HDV co-infection.

    **Since the transmission of this virus is similar to that of HBV, the precautions describedfor the care of the HBsAg positive patient will be followed.
    HBsAg-positive, as those HBsAg-positive
  55. Patients contagious for tuberculosis (TB) are ___ in the outpatient facility.
    not dialyzed
  56. Permanent Admission New to Dialysis OR Permanent Admission from a Non-DaVita Requirement

    Negative TST (one-step) completed within ...
    three (3)months prior to first treatment;
  57. Permanent Admission New to Dialysis OR Permanent Admission from a Non-DaVita Requirement

    Negative TST (two-step) completed ...
    within three (3)months prior to first treatment
  58. Permanent Admission New to Dialysis OR Permanent Admission from a Non-DaVita Requirement

    Negative QFT-G or T-SPOT completed within ....
    three(3) months prior to first treatment
  59. Permanent Admission New to Dialysis OR Permanent Admission from a Non-DaVita Requirement

    CXR and documented medical follow-up that was completed after a ...
    *IF the patient was found positive on the TST, QFT-G, or T-SPOT completed as the pre-admission test within the___ months prior tofirst treatment
    • positive test (TST, QFT-G, or T-SPOT)
    • three (3)
  60. Permanent Admission New to Dialysis OR Permanent Admission from a Non-DaVita Requirement

    CXR that was completed within three (3) months prior to first treatment for the patient who has a history of a ________ and can provide documentation of the medical follow-up to the ___ test (e.g. patient had completed treatment for latent TB infection);
    • past positive TSTor positive QFT-G or T-SPOT
    • pos.
  61. Permanent Admission New to Dialysis OR Permanent Admission from a Non-DaVitaFacility: Surveillance Requirements Following Admission

    Administer a second TST (2nd step of two-stepTST) __ to __ after the pre-admission TST was obtained or as soon as possible following admission, if three (3) weeks or more have passed since the pre-admission TST was done.

    If the 2nd step of theTST is negative, administer a one-step annual TST 12 months following patient admission or on the next scheduled annual testing date.Administer TB-RAQ on admission and annually.
    one (1) to three (3) weeks
  62. A Non-DaVita guest patient must provide documentation demonstrating a negative TST,QFT-G, or T-SPOT completed within ____ OR a CXRcompleted within three (3) months prior to first treatment.
    three (3) months prior to first treatment
  63. If a patient converts to a positive TST, QFT-G, or T-SPOT from a previously negative test, the patient should be referred for medical follow-up and evaluation for treatment of _____ . A CXR will be obtained prior to next treatment or no later than ____  from the positive finding.
    • latent TB infection or treatment of active disease
    • one (1) week
  64. Before returning to the outpatient dialysis facility, any patient receiving treatment for active pulmonary TB disease must have completed a minimum of ___ of appropriate tuberculosis therapy and
    -Demonstrate three (3) consecutive negative sputum smears for acid fastbacilli (AFB) that have been collected at least ___ apart
    -Be cleared for return to the outpatient dialysis setting by the localjurisdictional public health department and attending nephrologist
    -Will be instructed regarding the importance of taking the anti-tuberculosistherapy as prescribed
    -May participate in Direct Observed Therapy (DOT) for tuberculosis inconjunction and coordination with the local jurisdictional public health department
    -Participate in annual TB screening using the TB-RAQ only
    • one (1) week
    • 8 - 24 hours
  65. -HIV patients will be dialyzed in a ____ area.
    -HIV patients may participate in the dialyzer ___ program.
    -HIV patients ____ require a dedicated dialysis delivery system.
    -____ disinfection procedures are adequate for disinfection of the dialysis delivery system used for HIV positive patients.
    -The dialysis facility will not conduct routine testing of dialysis patients for HIV infection.
    • non-isolation
    • reuse
    • do not
    • Standard
  66. Patients who might be at increased risk for transmitting pathogenic bacteria include, but are not limited to, patients who:
    • Present with an infected wound with drainage that is not contained by dressings;
    • Are diapered or incontinent;
    • Have diarrhea not contained with personal hygiene measures;
    • Are unable to perform self care activities consistent with good personal hygiene
  67. Teammates caring for the patient with active Clostridium difficile (C. diff) infection must perform frequent hand washing, as ______ may not be effective to eliminate C. diff spores
    alcohol based hand gels
  68. Do not mix bleach and peracetic acid. If mixed, a chemical reaction occurs producing _____.
    toxic chlorine gas
  69. Do not use bleach for cleaning ______ in the reuse room or for re-useablereuse supplies.
    Use a _____ to clean environmental surfaces in thereuse room and reusable supplies
    • environmental surfaces
    • 1% peracetic acid solution
  70. Bleach solution needs to be covered with a secure lid and the solution should not be placed in the _____.

    NOTE: Without a secure lid, the bleach solution is open to aircausing the solution to degrade over time and become less effective.
    splash zone
  71. Bleach spills are classified as small spills (< __ gallons) or large spills (> __ gallons).
    • 5
    • 5
  72. In large bleach spills, If patients are present, ___ patients. Avoid inhalation by breathing fresh air.3. Call ______ immediately for assistance
    • evacuate
    • Fire Department and/oremergency response team
Card Set:
Infection Control
2017-03-16 21:41:53
dialysis infection control
In-center Hemodialysis P&Ps
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