Deck 3: Infection Prevention and Control in the Perioperative Setting

Question 1

The final step,after decontamination and before sterilization,is the prep,pack,and wrap process.The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization.Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.

A) Air-dry,inventory,inspect,lubricate,assemble and string instruments,wrap and tape
B) Inspect,unlock locked clamps,count and string instruments,place indicators,wrap and tape
C) Inspect,unlock locked clamps,string instruments,inventory,replace missing items,wrap
D) Inspect,inventory against list,assemble,place integrators,wrap and tape

Answer 1

D
The final step before sterilization for reuse includes instrument preparation and packaging.These activities occur in a clean area,separate from the area where decontamination occurred.Instruments are inspected carefully for cleanliness and functionality.Soiled instruments are returned for further cleaning.Instruments with movable parts are treated with a water-soluble lubricant solution that contains an antimicrobial agent to retard growth in the lubricant solution.Broken or worn instruments are set aside for repair.Instruments are assembled into sets according to set content lists prepared by perioperative nursing staff.

Question 2

All surgical patients present with the risk for hypothermia from a variety of factors inherent in the surgical experience.Hypothermia has been shown to be a factor that may place the surgical patient at risk for infection and delayed healing.Select the intervention that is an engineered control factor to protect the patient from hypothermia.

A) Surround the patient with a forced air-warming blanket and foil head covering.
B) Set the ambient room temperature between 68° and 73° F and limit exposure.
C) Line the OR bed with a circulating fluid mat and insert a rectal temperature probe.
D) Cover and surround the patient with several warm bath blankets and change them at frequent intervals.

Answer 2

B
Maintaining the ambient room temperature and limiting patient exposure is the first line of defense in protecting the patient from hypothermia.Temperatures in ORs should be maintained at 68° F (20° C)to 73° F (23° C).

Question 3

While antibiotics have been credited with saving lives,misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs).Antibiotic use is prolific in the perioperative setting.Select the antibiotic application has evidence to support it as a best practice and not,potentially,a misuse of antibiotics.

A) Antibiotics given IV within 1 hour of the incision for every procedure with an incision or entered body system
B) Vancomycin paste applied to cut edges of the sternum in cardiac surgery
C) Tobramycin and methylmethacrylate bead implants into deep orthopedic incisions at risk for osteomyelitis
D) Bacitracin ointment on a clean subcuticular sutured incision as part of the dressing

Answer 3

A
Drug resistance from treatment-related causes is often the result of misuse (e.g.,incorrect use,overuse,or underuse)of antibiotics.It is believed that 50% of all antibiotic use in the United States can be characterized by misuse in one form or another,and efforts to reduce surgical site infections include appropriate prophylactic antibiotic use in surgical patients.It is estimated that half of all antibiotic prescriptions written are not warranted.During antibiotic therapy,the patient may have retained a few resistant organisms.By natural selection,as the susceptible organisms are killed,the resistant organisms multiply and become predominant.Failure to perform sensitivity testing along with inappropriate dosing can contribute to resistance.Although some surgical complications are unavoidable,surgical care can be improved through decisions and subsequent care focusing on evidence-based practice recommendations.Research shows that delivering antibiotics to a patient within 1 hour of beginning surgery can dramatically decrease SSI rates,yet this practice is not followed in all situations.

Question 4

The design of the physical space within an OR attempts to minimize horizontal surfaces by placing cabinets flush with the wall.This prevents dust settling on multiple surfaces and decreases the areas that have to be monitored and cleaned.Another concern with horizontal surfaces is that air turbulence from staff movement and activity plus door movement,when it opens and closes,can:

A) mobilize resting dust from these surfaces.
B) contaminate sterile areas.
C) disrupt the unidirectional airflow.
D) All of the options are correct.

Question 5

Within a steam sterilizer,at a temperature of 100° C (212° F),the water condensation and the steam are the same temperature.This scientific phenomenon is called ___ and will __.

A) Steam saturation;not kill microorganisms
B) Steam distribution;promote microbial kill
C) Sterilization;kill all microorganisms to 106
D) Saturated steam;kill microbes at 106

Question 6

Sterilization prepares instruments to be used within,and on,sterile tissues.It kills vegetative microorganisms and endospores within a probability of 10⁶.The process of decontamination prepares instruments to be:

A) handled without gloves and prepared for sterilization.
B) free of bioburden and safely handled with gloves.
C) clean at a high level of disinfection.
D) None of the options are correct.

Question 7

The circulating nurse prepped the face,neck,and upper chest for a radical neck dissection.After removing the protective towels around the prep site,the surgical fellow applied the head drape and the rest of the patient was draped.During the preincision surgical time-out,the fire risk score was determined to be high.When the surgeon reentered the room,after leaving the room to scrub,and donned her gown and gloves,she noticed an area on the neck that did not look prepped.She asked for prep solution on a sponge and sponge forceps to complete the prep area,taking care not to moisten the head drape.After handing off the used sponge forceps she asked for the scalpel.What step was omitted in this process?

A) The new prep area was not given time to dry.
B) The time-out should have been repeated with the surgeon scrubbed.
C) The patient should have been reprepped and redraped with all new drapes.
D) The scrub person should have given the surgeon a sterile towel to cover the unprepped area.

Question 8

The hospital epidemiologist was alerted when several cultures had recently revealed suspicious similarities.He was concerned about two unrelated patients with similar abscesses in similar body regions.Susan Grant,a 72-year-old diabetic patient taking immunosuppressive medications for chronic Crohn's disease,had an incision and drainage of a perianal fistula.Shawn Ames,a healthy 22-year-old college student and motocross racer,had an incision and drainage plus excision of a pilonidal cyst.Both patients cultured out a new subtype of S.aureus.Susan's specimen results showed a significant colony growth of S.aureus plus differential growth of coagulase-negative S.epidermidis,while Shawn's specimen was a high colony growth coagulase-positive,similar subtype of S.aureus.The epidemiologist charged his department to be alert for this S.aureus subtype and cross-check for trends.He was most concerned about one of these patients in particular and pulled up the medical record for review.Which patient may be at higher risk with the more virulent strain and why?

A) Susan because she is immunocompromised and elderly and has Crohn's disease
B) Shawn because he has pilonidal sinus tracts from sacral pressure caused by racing
C) Susan because she has a mixed microorganism culture that is coagulase negative
D) Shawn because he has a high microbial load that is coagulase positive

Question 9

Ernesto Horn was admitted to the emergency department (ED)with respiratory symptoms,facial and upper body abrasions,burns,and moist lesions after a small package,delivered to his office,exploded and sprayed him with dried powder and glass shards.In response to the reported mechanism of injury,the ED team sequestered him in a secluded area away from the rest of the patients.The team believed that this was highly suspicious of a bioterrorism event.The epidemiologist was called and the patient was transferred to a negative-pressure isolation room and placed on Standard,Contact,Airborne,and Droplet Precautions.Based on these actions,what microorganism agents might be suspected to be involved?

A) Plague and tuberculosis
B) Smallpox and tuberculosis
C) Ebola virus and anthrax
D) Anthrax and smallpox

Question 10

Surgical site infections (SSIs)are most often caused by gram-positive cocci and may arise from the patient's own endogenous sources.The most typical causative microorganism cultured from SSIs is:

A) Staphylococcus epidermidis.
B) Streptococcus pyogenes.
C) Staphylococcus aureus.
D) Enterococcus.

Question 11

The mechanism of lethality (microbial death)with steam sterilization is achieved with this event.

A) Time,temperature,and steam pressure
B) Reduced and limited mitosis within the bioburden
C) Saturated vaporization of the microbial cytoplasm
D) Denaturation and coagulation of enzyme proteins

Question 12

Positive-pressure air handling systems with unidirectional flow of non-recirculated air from the ceiling to the floor are designed to:

A) create mild air turbulence to prevent dust from settling on surfaces.
B) augment the oxygen-enriched environment with dust-free air.
C) flow clean air over the patient and prevent corridor air intake.
D) All of the options are correct.

Question 13

Qualities of an effective packaging material must include these key characteristics.Select the three most important qualities.

A) Cost,good barrier,lint-free writable surface
B) Good steam penetration and removal,good barrier,aseptic presentation
C) Aseptic presentation,event-related sterility indicators,writable surface
D) Stackable in sterilizer/storage shelf,comparable cost,low toxicity

Question 14

A swab of a fluid collection from an edematous,red,and separating postoperative wound is sent to the microbiology lab for culture,sensitivity,and Gram stain.The surgeon expects that the result will show a gram-positive coccus.This Gram stain designation is based on the:

A) ability to cause plasma to coagulate and form a microscopic clot.
B) physical and chemical properties of the cell wall.
C) formation of aerobic clustered spheres.
D) appearance of a thicker and brownish colored cell wall.

Question 15

With the production of more steam in the sterilizer chamber,the pressure increases as well.The steam should contain little or no entrapped liquid water.Steam quality is the term that describes the amount of water mixed with the steam.The constitution of high-quality steam would be measured by:

A) 97% or greater.
B) 100%.
C) <3% of the mixture is liquid water.
D) All of the values are correct.

Question 16

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations.However,disinfection differs from sterilization in that the process for disinfection uses:

A) contact Precautions as well as Universal Precautions.
B) hospital-grade disinfectant/sterilants.
C) semicritical medical devices used for ambulatory procedures.
D) agents to disinfect and eliminate most,if not all,pathogenic microbes.

Question 17

The Centers for Disease Control and Prevention (CDC)has identified pathogens that could pose a threat to national and world security and safety through bioterrorism.Select the four most probable agents that could be used to cause mass transmission,mortality,panic,and social disruption.

A) Anthrax,tuberculosis,C.difficile,tularemia
B) Smallpox,plague,botulism,tularemia
C) Smallpox,monkeypox,avian influenza,anthrax
D) Anthrax,H1N₁ influenza,botulism,smallpox

Question 18

The evening before the procedure was scheduled,the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation,four flexible coated retractor blades,and a sterilized internal paper inventory form.The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants,but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220° F.The appropriate sterilization option for these instruments and devices would be:

A) hydrogen peroxide gas plasma sterilization for everything.
B) steam sterilization for the implant sets and paper inventory form,hydrogen peroxide gas plasma for the retractors,wrapped separately.
C) steam sterilization for the implant sets,hydrogen peroxide gas plasma for the retractors and paper inventory form,wrapped separately.
D) steam sterilization for everything with a shortened dry time.

Question 19

An integrator is a multiparameter indicator designed to measure:

A) time and pressure.
B) pressure,steam,and temperature.
C) temperature,time,and presence of steam.
D) sterility and pressure.

Question 20

Willard Braun was admitted to the ICU 3 weeks ago for heart failure and intractable atrial fibrillation.He has had diarrhea for 4 days that has cultured C.difficile.The transmission-based precautions sign on the door to his room alerts the staff to employ:

A) Contact Precautions with eye protection.
B) both Standard Precautions and Contact Precautions.
C) body substance isolation.
D) droplet Precautions with standard isolation technique.

Question 21

Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member;however:

A) it can only be used for the initial gloving.
B) it requires two people to execute without contamination.
C) there is a risk of contamination if the thumbs are not extended.
D) All of the options are correct.

Question 22

If a sterile glove becomes contaminated during the procedure,the best practice for corrective action is:

A) reglove with open-glove or assistive glove technique.
B) reglove with closed-glove technique.
C) remove gown and gloves and regown and reglove.
D) place a new sterile glove over the contaminated glove.

Question 23

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins __ and _ before and after the procedure.

A) At the vagina and perineum;the nurse should check with the anesthesia provider before touching the patient
B) At the incision site to the periphery of the abdomen only the nurse should begin and complete perioperative documentation of skin preparation including wound classification
C) At the cleanest area first and proceeds to less clean areas (abdomen then vagina/perineum);a skin assessment should be performed
D) At the vagina and perineum first with urinary catheter insertion and then proceeds to the pelvic abdomen;a skin assessment should be performed

Question 24

When applying sterile drapes to create the sterile field on the patient,which of the following principles is most important?

A) The circulating nurse should monitor the scrub person's gowned arms when reaching over the unsterile parts of the patient.
B) Gently shake and fan out the drapes to open up the folds before approaching the patient.
C) Drape the patient starting with the incision area and proceeding to the periphery.
D) All of the options reflect violations of sterile technique.

Question 25

The transplant team received the liver from the procurement team moments after it arrived by medical air lift.The OR was ready with a scrubbed team of a circulating nurse,scrub person,transplant surgeon,and surgical resident and with a sterile back table set up and counted to prepare the liver for transplant.As the surgeon began to dissect out the liver vessels,he realized that the liver could reasonably serve two recipient patients and he had another suitable donor candidate.The surgeon was aware that all of the available OR rooms were blocked and running until midnight,and the second patient could not be scheduled until this case was finished.As he carefully segmented and split the liver,the second patient was contacted to come to the medical center.The anesthesia provider transported the original intended recipient patient into the room and proceeded to prepare and induce the patient with a general anesthetic.The circulating nurse suddenly realized the sterile technique violation dilemma after the patient was asleep.Which option best reflects appropriate sterile technique and the best care for both patients?

A) The patient should have been taken to a second available OR,not the room with the liver dissection underway,since it was being split for two patients.
B) The patient should have been held in preoperative holding until the liver was split and the second segment placed back into the cooler.
C) The back table should have been covered with sterile drapes and moved to a second available room.
D) The surgeon should proceed with splitting the liver,replacing the segment for the second patient back into the cooler,and storing the cooler in the back of the OR for the second transplant patient,whose procedure will follow in the same OR.

Question 26

In several studies,it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pairs of sterile surgical gloves,as opposed to wearing one pair.Select the correct statement that refers to double gloving in terms of a best practice.

A) The Centers for Disease Control and Prevention (CDC) endorses double gloving for all surgery and invasive procedures.
B) Wearing two glove layers permits regloving using the closed-glove technique for a contaminated glove.
C) Wearing a glove liner between both layers of gloves may eliminate the risk of perforation to the inner glove,protecting the wearer from sharps injury.
D) The AORN publication titled Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting recommends the double-glove procedure during invasive procedures.

Question 27

Which of the following choices reflects the appropriate order of four of the steps in preparing for the surgical hand scrub procedure?

A) Wash hands and wrists,remove jewelry,replace mask and eye protection,contain hair.
B) Contain hair and earrings in hat,wash hands and clean under nails,place mask and eye protection,remove jewelry.
C) Remove jewelry,contain hair,don fresh mask and eye protection,wash hands and forearms.
D) Don fresh mask,contain hair,place eye protection,clean under nails.

Question 28

Describe the best practice for aseptic removal of sterile gloves after removal of the sterile gown at the end of the procedure.Select the best practice to protect the wearer from cross-contamination.

A) Remove both gloves together using the gloved fingers of one hand to secure the everted cuffs of the other hand,turning both gloves inside out.Discard gloves in regular trash since they are inside out.Remove mask by the ties and wash hands.
B) Using the gloved fingers of one hand to secure the everted cuff,remove the glove,turning it inside out.Discard appropriately.Using the ungloved hand,grasp the fold of the everted cuff of the other glove and remove the glove,inverting the glove as it is removed.Discard in biohazard trash.Remove mask by the ties and discard.Wash hands.
C) Both practices are appropriate.
D) Neither practice is appropriate.

Question 29

Effective instrument decontamination is dependent on a particular sequence designed to lower bioburden to the lowest level.Number the steps below to reflect the correct order of processing a basic set of laparotomy instruments through decontamination.
a.During surgical procedure,wipe instruments with sterile water.
b.Transport in closed container to decontamination area.
c.Employ ultrasonic washer.
d.Preclean with neutral enzyme agent in leakproof container in procedure room.
e.Disassemble and unlock all instruments;place heavy instruments on bottom.
f.Rinse with cold water in deep sink.
g.Remove and discard all disposable sharps.
h.Place in automated instrument washer/decontaminator.

Question 30

Sterile surgical drapes are used to create the sterile field,protecting the patient from endogenous and exogenous sources of contamination.Of the characteristics listed,which are essential to maintaining the sterile field?

A) Provide barrier protection from microorganisms,fluid,and particulate matter
B) Limit environmental impact and flammability
C) Ensure a fiscally responsible cost/benefit ratio and reduce glare
D) All of the options are important.

Question 31

Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?

A) Mask,gown,gloves,shoe covers
B) Gown,lead apron,shoe covers,mask,gloves
C) Mask,gown,hat,gloves
D) Gown,gloves,mask

Question 32

To protect the forearms,hands,and clothing from contacting bacteria on the outside of the used gown and gloves,members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves.Which choice lists the appropriate first 3 steps in the removal of the sterile gown?

A) Wipe gloves clean,untie side gown closure,grasp gown at one shoulder seam.
B) Wipe gloves clean,grasp gown at both shoulder seams,pull over and off arms.
C) Unfasten gown back closures,grasp gown at one shoulder seam,pull down over both arms and gloves while everting glove cuffs.
D) Grasp both gown shoulders,slide gown down over arms,grasp gloves inside gown sleeves and pull gown and gloves off together.

Question 33

Decontamination of the hands can be done by a variety of methods.The Joint Commission (TJC)states that a thorough handwash with an antimicrobial agent may be as effective as the traditional surgical scrub using a brush or sponge.Facility infection control procedures govern the selection of materials and the methods used for surgical hand hygiene.Select the best practice for surgical hand hygiene.

A) Alcohol-based hand rub
B) Anatomic counted strokes with 4% chlorhexidine gluconate brush
C) Anatomic timed strokes with povidine iodine sponge
D) Any of the options with an antimicrobial hand wash

Question 34

Which glove lubricant,used to facilitate easy donning,is considered a best practice?

A) Sterile talcum or corn starch powder
B) Sterile petroleum-based oils
C) Sterile silicone film
D) None of the options is a best practice.

Question 35

The surgical hand scrub is designed to render the hands,nails,and arms:

A) surgically clean.
B) free of transient microorganisms,dirt,and skin oils.
C) coated with residual antimicrobial residue to prevent microbial regrowth.
D) All of the options are correct.