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Block 4 SCCJA Collision reporting
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- Crimes Against Property - SCCJA.
Block 4 SCCJA Collision reporting
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3 main causes of vaginitis - ANS-Trichomoniasis, vulvovaginal candidiasis, bacterialvaginosis
Abnormal number or function of granulocytes - ANS-Leukemia, chemo, congenital
disorders, diabetes. If short term (< 2 wks) then aerobic GNR, Sa, CoNS. IF long term,
add fungi (candida, t. glabrata, aspergillus)
Abnormalities of cell-mediated immunity - ANS-BMT, HIV, steroids, malnutrition, 3rd tri
pregnancy. Bacteria: Intracellular pathogens (listeria, salmonella, mycobacteria,
nocardia, legionella).
Fungi: candida, Cryptococcus, coccidioides, histoplasma. Virus: Herpes group
Also toxoplasma and strongyloides.
abnormalities of humoral immunity - ANS-BMT, HIV, some cancers, aging. Strep
pneumo, encapsulated H. flu, Neisseria meningitidis
Adult learners - ANS-Are autonomous and self directed; have experiences and
knowledge already. Are oriented towards goals and relevancy/practical. Must be shown
respect. Engaging learners in formulating the objectives for the education is helpful.
Generally prefer more active learning activities; teaching others/immediately using
learning is the most likely to result in retention.
AIIR design - ANS-At least one in acute care facilities; new places should have "a
sufficient number" based on patient poulation, community/facility past experience,
mission and goals of facility, and resources available in the community. Some special
care areas require more. Air should flow from corridor into room, and then be exhausted
outside or passed through a HEPA filter before recirculation. 12 ACH per hour.
Anteroom not required. Self-closing doors and permanent visual indicator of pressure
status.
AIIR specifications - ANS-AIIR should have negative air pressure relative to the hallway.
Minimum 6-12 air exchanges per hour; new facilities should have 12. Air from room
should vent directly outside, away from any air intakes. If must be recirculated, must go
through a HEPA filter. Pt's door should stay closed and have an automatic closer plus a
permanent visual monitoring system of flow. Rooms should be inspected daily if have
patient, monthly full inspections. No risk to general patients placed in AIIR.
Air changes HVAC - ANS-Measured in ACH, air changes per hour. A minimum of 2 is
needed to remove odors, but 6 is more comfortable. Some areas have higher
,requirements. There are no requirements about how often ACH must be measured, but
there should be a schedule.
Air flow distribution HVAC - ANS-Air should flow from "clean" to "less clean" areas. Air
usually enters from the ceiling with an exhaust intake near the floor. ORs may have
directional airflow of superclean air- should be in the style of the new slower flow rather
than old high velocity LAF.
Air pressure HVAC - ANS-Air pressure balancing is the whole +-netural pressure
process. + pressure is used to keep bugs out: used in ORs and sensitive patient areas.
Neg pressure is used to keep bugs in. Pressure balancing is very sensitive-
doors/windows must be closed in isolation rooms.
Air Source HVAC - ANS-All air is conditioned by filtering, heating/cooling, and adjusting
humidity. Can use outside air or recirculated, or a mix. Outside air dilutes microbial
contamination, gases, and controls odor. Recirculated air conserves energy; must not
be allowed to mess with pressure arrangements. Fresh air intakes must be at least 25
feet from vents/exhausts. Central air intakes must be as high as practical, at least 6 feet
or 3 ft off the roof. Exhaust outlets should be above roof level and arranged to minimize
recirculation back into the building.
Animals in healthcare - ANS-Policies for volunteer "therapy animals" exist; should
include temprament, obedience, and health testing. Should be facility policies governing
when/where/with whom. Pets may be allowed in certain special situations, such as
terminal illness. Pets must be bathed within 24 hrs, be escorted, and only interact with
the patient and their family. Service animals generally allowed but may be excluded
from ORs/burn areas/where sterility is key. Can ask if the service animal is required and
what they do, but cannot ask for documentation of disability/service dog status.
Antifungal mechanism of action - ANS-Echinocandins (casopfungin) work on the cell
wall synthesis process. Azoles work to prevent sterol synthesis, which affects the cell
membrane
Arbovirus life cycle - ANS-Reservoir="amplifying host" that has high viremia but lower
mortality. An arthropod vector transmits the virus to dead end hosts, like humans.
Arterial Blood Gas (ABG) - ANS-blood from artery, measures oxygen and CO2 tension,
pH. Assesses gas exchange, which is helpful in recognizing pneumonia
Bacterial vaginosis diagnosis - ANS-1) vaginal pH greater than 4.5
,2) unpleasant fishy odor after adding KOH to secretions
3) wet mount shows epithelial cells covered in bacteria
4) heterogeneous thin white discharge that smoothly coats the vaginal walls
Gold standard is a gram stain showing mostly gram negs and few lactobacilli; can do
PCR but limited utility.
Bacterial vaginosis overview - ANS-Multispecies infection, knocks out normal
lactobacilli. Frequently asymptomatic. Associated with having multiple sex partners, but
no clear sexually transmitted pathogen. Generally more mild Sx than VVC or trich.
Standard precautions.
Bed bug diagnosis - ANS-New infections: itchy bumps. Repeat infections: more severe.
Generally diagnoses by suspicious symptoms + finding bed bugs in the home.
Bed bug infection prevention - ANS-Patients with bed bugs at home probably will not
bring to hospital. If bed bugs in hospital, call pest control to get a licensed exterminator.
Can use hot laundering for bedding and clothing, not usually necessary.
Beg bug epidemiology - ANS-up to 7 mm in length. Crawl out to feed on humans/other
mammals at night. Not known to transmit other diseases. Can live for months without
feeding while hiding in nooks and crannies.
Biofilm treatment and prevention - ANS-Prevent adherence with antimicrobial surfaces,
exemplary sterile technique. Probiotics may help.
Once exist: physically remove/debride the biofilm, abx to prevent regrowth. Removing
devices.
Black vs gray water - ANS-Black contains sewage contaminants. Gray is used but
doesn't contain serious contaminants- such as sink or bath water.
Blood exposure prevention - ANS-Hollow bore needles full of blood are most commonly
associated with BBP transmission. Use devices designed to prevent injury. Don't use a
needle if needleless access is possible; switch to needleless systems. Avoid
manipulating needles as much as possible, esp during disassembly. Suture needle
injuries are common but less risky for BBP; same recs. In general, avoid sharp things
when possible.
Body lice transmission - ANS-Direct contact with louse, clothing, or bedding. Lice cling
to clothing. Can live 4-7 days off of a human.
, Body passage obstruction; examples and associated pathogens - ANS-Tumors, foreign
bodies, stones, cystic fibrosis. Resident flora overgrow or invade; site-specific.
Body piercing infection control - ANS-Association of Professional Piercers recommends
only sterile disposable equipment be used; prefer single use sterile needles. Stud guns
can become contaminated by aerosolized blood; should either use disposable
cartridges and be alcohol-wiped or be HLDs. Jewelry used should be smoothly polished
and easily cleaned; certain metals preferred. Infections for normal piercings act like
SSIs; skin flora most common, some atypical mycobacteria. Piercings through mucous
membranes have risk of more serious infections like endocarditis; mouth piercings have
dental risks.
C diff infection prevention - ANS-Glove use by HCP is key. Disposable items help.
Cohorting. Cleaning with sporicidal agents helps in areas with high rates but studies
don't show an effect on lower rate areas.Contact precautions until patient is not
symptomatic; room will be highly contaminated until terminally cleaned. ABHR doesn't
inactivate spores, but switching to soap and water justified only in outbreak situations.
Careful antibiotic selection and minimal use prevents disease in colonized patients.
C diff microbio - ANS-Gram pos, spore forming, anaerobic. Makes 2 toxins and the
epidemic NAP1/027 strain makes 3. Anyone can be colonized, but disease requires
disruption of the normal flora by antibiotics or chemo. Can get a nontoxigenic strain,
which won't cause disease. Can get a protective immune response if antibodies to toxin
A are formed
C diff testing - ANS-Only test symptomatic patients; do not do "test of cure". Many test
options with different strengths and weaknesses. Culture is most sensitive but will also
be positive for nontoxigenic strains and takes a week. EIAs are fast and specific, but not
sensitive enough as a stand-alone. PCR has great parameters but is $$ and can get
positives for asymptomatic patients.
CAP epi+ treatment - ANS-4 most common pathogens are strep pneumo, h flu,
moraxella catarrhalis, and staph aureus. There are also atypical pathogens, and most
Enterobacteriaceae. Always suspect TB if there are any risk factors. Suspect an MDRO
if recent abx, current hospitalization of 5+ days, or that's common in area. People with
recent abx, kidney disease, IVDU, and recent flu are at higher risk for SA CAP. People
with structural lung disease or chronic steroid use are at increased risk for
Pseudomonas.
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