Can You Pass This Infection Prevention Quiz?

Staff Safety Wound Closure Instrument Reprocessing and Care Infection Prevention

By: Adam Taylor | Senior Editor

Published: 11/16/2022

Share:

Test your staff’s knowledge on instrument cleaning, sharps safety, wound care and other ways to keep patients and staff safe.


Infections can be catastrophic. They're potentially deadly to patients and staff, expensive to treat, can force a second surgery and are unpleasant to litigate. Use this quiz to see if you're up to date on the latest infection prevention practices and see what experts have to say about the advances that help patients and staff stay healthy and safe.

1. Immediate point-of-use treatment and the prompt transport of surgical instruments to sterile processing lessens the importance of manual cleaning before the disinfection/sterilization process.

  • a. True
  • b. False
  • Reveal

    • Answer: b
      Treating soiled tools at the bedside with an enzymatic spray or foam and keeping them moist for the duration of the case are frequently overlooked components of comprehensive instrument care. Point-of-use treatment removes bioburden in a far easier fashion than if it's left to harden on instruments by the time they arrive in the sterile processing department (SPD). And keeping instruments wet loosens debris that remains while they sit waiting for treatment by a reprocessing technician. While point-of-use treatment is overlooked by some, it's often overvalued by those who do employ the practice, says Benjamin D. Galvan, MLS(ASCP)CM, CIC, an infection preventionist at Tampa General Hospital. "Some facilities consider the point-of-use treatment as a substitute for the manual cleaning process, when in fact they are two different steps," says Mr. Galvan. "Even when you pre-treat properly — wiping instruments after they're used and soaking them before they arrive in decontamination — you're not really cleaning everything. Instruments that arrive in SPD after being treated, while in much better shape than not having been wiped down, still aren't ready to go straight to the sterilization process."
      Close

2. Healthcare workers on the wrong end of a needlestick are at risk of contracting HIV, hepatitis B and hepatitis C. Which is the most likely infection to occur?

  • a. hepatitis B
  • b. hepatitis C
  • c. HIV
  • Reveal

    • Answer: a
      Many healthcare workers are most concerned about hepatitis C or HIV if they are injured by a syringe, scalpel or suture, but they are less likely to suffer those conditions than a hepatitis B infection, says Mr. Galvan. Surgical personnel should obviously be worried about all bloodborne pathogens, but there is a 30% risk of percutaneous transmission of hepatitis B, compared to a 1.8% chance of transmission of hepatitis C and only a 0.3% risk of transmission of HIV. The Association for periOperative Registered Nurses (AORN) says as many as 90% of sharps injuries go unreported. AORN stats show that about 385,000 hospital workers suffer one each year — and it's believed injuries occur in as many as 15% of all surgeries in the U.S. More than half of the injuries are estimated to be preventable. "You should never rush when you're dealing with sharps and should make sure to use products designed to keep you safe, such as plastic passing trays, blunt-tipped suture needles and retractable scalpels when appropriate, as well as closed disposal containers," says Mr. Galvan.
      Close

3. What are the two most frequently missed steps when instruments are cleaned prior to disinfection and sterilization?

  • a. proper transport and cleaning
  • b. drying and inspection
  • c. rinsing and safe repackaging
  • Reveal

    • Answer: b
      It's not unusual to see instruments not get dried properly and go uninspected before they go into the sterilizer. These two critical components of proper instrument care are often skipped, according to Luci Perri, RN, BSN, MSN, MPH, CIC, FAPIC, CSPDT, owner and president of Infection Control Results, a Charlotte, N.C.-based consulting company. In addition to being skipped at times, sometimes they're occasionally performed in the wrong order. Instruments should be dried before they're inspected. "Water distorts the image of whatever might be on the instruments, making it difficult to see bioburden or damage," says Ms. Perri. "After instruments come out of the washer, they should be dried first, then inspected. After that you can go ahead and package them for sterilization."
      Ms. Perri believes many SPD workers simply don't know they're supposed to be drying and inspecting prior to sterilization. "They're the two most frequently missed steps taking place in outpatient settings," she says. "They're important, because if the inspection shows biological soil remains, the instruments should be sent back to be rewashed. If damage is detected, the instruments should be repaired or replaced."
      Close

EXTRA SUDS Endoscopes that aren’t manually cleaned within an hour of bedside cleaning should be soaked for an extended period of time.

4. What's the best way to assign cleaning duties for OR turnovers?

  • a. by job title
  • b. to specific individuals at the start of each day
  • c. to individuals or by title on a monthly or weekly basis
  • d. a or b
  • e. b or c
  • Reveal

    • Answer: d
      You should formalize which team members perform each task and when each item in the room should be cleaned, while establishing a way to confirm that nothing was missed — even if everything always seems to get cleaned and your infection rates are low. "If you don't have a standardized process, someone will disinfect a back table, then another person will come in after it has dried and disinfect it again," says Ms. Perri. "It's not the worst thing for something to be cleaned twice. The problem is, time is of the essence and recleaning something increases the chance that something else will get missed."
      Tasks can be assigned based on job title, or they can be assigned at the start of each day. Making the assignments too far in advance could lead to confusion when people call out sick and per-diem employees are working. No matter who's responsible for what on a particular day, the sequence of what gets cleaned should remain the same. "Whatever the process, team members should know what they're going to be cleaning in advance and have a way to communicate with their colleagues about what's been cleaned and what hasn't," says Ms. Perri. "Otherwise, the cleaning process is too chaotic."
      Close

5. FDA guidance says dirty flexible endoscopes should undergo an extended soak time if an hour passes before they're reprocessed. When does the clock start ticking?

  • a. immediately after the scope has been used
  • b. after pre-cleaning at the bedside
  • c. when the scope is removed from the procedure room
  • Reveal

    • Answer: a
      The FDA counts the hour from the time scopes are removed from the patient to the start of the manual cleaning process. Frank Myers, director of infection prevention and clinical epidemiology at UC San Diego Health, sees many care teams start the countdown clock at the wrong time. "In a multi-scope procedure, physicians will use one scope, set it aside, then complete the case," he explains. "That first scope will often sit for more than an hour before it will get cleaned, which puts it into the FDA's extended scope time guidance. From my perspective, this arises from not understanding what extended scope times are for, and what the implications are of them not being implemented when appropriate. Also, a lot of providers assume the guidance isn't triggered until the moment the scope leaves the room, but the time actually begins as soon as the scope has stopped being used during the procedure."
      Close

SAFETY FIRST Sound practices such as using a plastic tray for a neutral passing zone reduce the chance of an OR team member acquiring dangerous bloodborne infections.

6. What's the correct course of action for a reprocessing tech who is moving a flexible endoscope from the manual cleaning sink to the automated endoscope reprocessor (AER)?

  • a. walk it over in existing PPE
  • b. change gloves, but keep the gown on
  • c. change the gown and gloves
  • Reveal

    • Answer: c
      Techs often get into trouble by mistakenly considering the scope dirty because it hasn't yet undergone high-level disinfection. They therefore simply transport the scope to undergo the next step of the process — getting run through the AER — still wearing the gown and the gloves they donned to clean it. This is a common mistake, says Mr. Myers. "They handle the AER, which means the next person who touches the machine is going to unknowingly contaminate their hands before they take the scope out, which is a problem since they're working on the side of the room where instruments should not need to be recleaned." After the scope is soaked and manually cleaned in the sink, the tech should put on clean gloves and a new gown to carry it to the AER.
      Close

7. How often, and by whom, should the sponges in a negative pressure wound therapy vacuum be changed?

  • a. Never. The surgeon's dressing should not be opened
  • b. Every 24 hours by the patient
  • c. Every 48 to 72 hours by a visiting nurse
  • d. Every 84 to 96 hours by the patient
  • Reveal

    • Answer: c
      The main purpose of negative pressure wound therapy using vacuum suction dressings is to promote faster and healthier healing, which is accomplished by a reduction in swelling around the surgical site, stimulation of new tissue in and around the wound and the prevention of infections.
      After a surgeon closes the wound, they place a sponge atop the incision. The negative pressure from the vacuum dressing keeps the sponge in place and extracts fluids from the wound, which prevents bacteria that can cause SSIs from proliferating, says J. Gabriel Horneff III, MD, FAAOS, an assistant professor of clinical orthopedic surgery in the shoulder and elbow division at the University of Pennsylvania in Philadelphia. In most cases, the sponges will get saturated in two or three days. "Making sure the patients have to do as little work as possible is always the best road to good outcomes, so set them up with a wound care nurse to change the sponge, dressing and tubing," says Dr. Horneff. "They should also be sent home with detailed discharge instructions that include directions about how to remove and reattach the tube from the dressing for when they have to take showers."
      Close

WHO DOES WHAT Everyone involved with room turnovers should have their tasks assigned to them in advance.

8. What percentage of surgical site infections can be traced to patients' own nasal flora?

  • a. 50%
  • b. 60%
  • c. 70%
  • d. 80%
  • Reveal

    • Answer: d

      Research suggests 80% of SSIs are caused by the patient’s own skin flora and approximately 30% of the general population is colonized with Staphylococcus aureus in their nares. The question is: Whose nares should you treat preoperatively? There's no one correct decision, and it often comes down to some combination of consensus among facility leaders, individual surgeon preferences and a financial business decision. Most facilities opt for a universal program that treats all patients on the day of surgery with povidone-iodine or an alcohol-based antiseptic, or a targeted one that screens and treats those who test positive, says Mr. Galvan. With the risk of infection still relatively low and the price of screening everyone relatively high, some facilities, such as White Fence Surgical Suites in New Albany, Ohio, implement a hybrid approach. They test high-risk patients only, such as people on renal dialysis, those who live in nursing homes, healthcare workers or people with indwelling catheters. Patients with a past staph infection or an infection of unknown origin are tested as well. The treatment regimen for White Fence patients who test positive consists of five days of nasal mupirocin and five days of chlorhexidine gluconate (CHG) showers. Their wound sites are also treated with CHG wipes immediately before surgery. OSM

      Close

Related Articles

Wired for Success

Adam Taylor | Managing Editor 4/15/2024

In her 24 years as a nurse at Penn Medicine, Connie Croce has seen the evolution from open to laparoscopic to robotic surgery....

To Optimize OR Design, Put People First

Anjali Joseph, PhD, EDAC 4/15/2024

Through my decades of researching, testing and helping implement healthcare design solutions, I’ve learned an important lesson: A human-centered and evidence-based...