Infection Control

Published on 12/06/2015 by admin

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Last modified 12/06/2015

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2 Infection Control

Note 1: This book is written to cover every item listed as testable on the Entry Level Examination (ELE), Written Registry Examination (WRE), and Clinical Simulation Examination (CSE).

The listed code for each item is taken from the National Board for Respiratory Care’s (NBRC) Summary Content Outline for CRT (Certified Respiratory Therapist) and Written RRT (Registered Respiratory Therapist) Examinations (http://evolve.elsevier.com/Sills/resptherapist/). For example, if an item is testable on both the ELE and the WRE, it will be shown simply as (Code: …). If an item is testable only on the ELE, it will be shown as (ELE code: …). If an item is testable only on the WRE, it will be shown as (WRE code: …).

Following each item’s code will be the difficulty level of the questions on that item of the ELE and WRE. (See the Introduction for a full explanation of the three question difficulty levels.) Recall (R) level questions typically expect the exam taker to recall factual information. Application (Ap) level questions are more difficult because the exam taker may have to apply factual information to a clinical situation. Analysis (An) level questions are the most challenging because the exam taker may have to use critical thinking to evaluate patient data to make a clinical decision. For example, [Difficulty: ELE is R, Ap; WRE is An].

Note 2: A review of the most recent Entry Level Examinations (ELE) has shown that an average of four questions (out of 140), or 3% of the exam, will cover infection control issues. A review of the most recent Written Registry Examinations (WRE) has shown that an average of two questions (out of 100), or 2% of the exam, will cover infection control issues. The Clinical Simulation Examination is comprehensive and may include everything that should be known or performed by an advanced level respiratory therapist.

MODULE A

1. Hand washing or cleansing

Hand washing or cleansing is probably the single most important procedure for reducing the spread of infection. Washing with plain soap and warm tap water is acceptable in most cases. Antimicrobial soap should be used if called for in the infection control protocol. In many institutions, an isopropyl alcohol and skin softener/cleansing agent is used unless the hands are obviously contaminated. When contaminated with body fluids, the hands should be washed. In any case, respiratory therapists should wash or cleanse their hands before and between each patient contact. The following times are recommended when working in a general patient care area:

The most common bacterial organisms spread by personal contact are Staphylococcus aureus, Escherichia coli, and Streptococcus species. Suspect personal contact and poor hand cleansing whenever a patient has one of these infections.

2. Standard precautions

Standard (formerly called Universal) Precautions are designed for the care of all patients, regardless of their diagnosis or presumed infection status. Barriers such as gloves and masks and other procedures are used to prevent contact with body fluids. This approach to patient care has been adopted because of the concern of health care workers and the public that the human immunodeficiency virus (HIV), hepatitis B, or other deadly pathogens may be spread unknowingly by contact. Box 2-1 includes specific standard precaution guidelines established by the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA).

BOX 2-1 Precautions to Prevent the Spread of Infection

4. Respiratory care equipment and procedures

The following guidelines are recommended to minimize the spread of infection by equipment and procedures. Follow the manufacturer’s specific guidelines when applicable:

5. Implement transmission prevention protocols

Transmission prevention protocols are used for patients known or suspected to be infected or colonized with epidemiologically significant pathogens, which are spread through airborne or droplet transmission or by contact with dry skin or contaminated surfaces. These protocols are used in addition to Standard Precautions. The following are general guidelines and specific diseases or conditions established by the CDC for the three types of patient isolation categories. Hospitals may establish extra standards and post them at the door to the patient’s room.

a. Airborne precautions

Airborne Precautions are used in addition to Standard Precautions for patients with known or suspected illnesses transmitted by airborne droplet nuclei (these include pulmonary tuberculosis [TB], varicella [chickenpox], rubeola [measles], and avian influenza [flu]), and when severe acute respiratory syndrome (SARS) is known or strongly suspected.

c. Contact precautions

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