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Test 5: Infection control considerations for healthcare facility design

  1. The most important consideration when designing a new healthcare facility is:
    • The budget available for the project
    • The disease profile of the local community
    • The community’s stated service needs
    • The existing facilities available in the area.
  2. Infection control practitioners should be involved in healthcare facility design because:
    • They can advise on design elements to reduce healthcare-associated infection (HAI)
    • They will have to work in the facility once built
    • They know better than clinicians what is required for a new building
    • They are required by law in all countries to be involved in all building projects.
  3. Infection control practitioners should be involved in healthcare facility design:
    • Just before the ward is opened to admit new patients
    • Just before the building or renovation work starts
    • After the approved plans have been received from the architect
    • When the ideas for the building or renovation are first being discussed.
  4. Infection control practitioners should advise on the following aspects:
    • Resuscitation and clinical equipment needed
    • The colour of the walls and floors
    • Isolation rooms, ventilation, layout and fittings
    • The admission criteria for patients to the new ward/area.
  5. Beds in the general wards should be separated by at least:
    • 2.5 metres (centre of bed to centre of next bed)
    • 3.0 metres (edge of bed to edge of next bed)
    • 3.5 metres (centre of bed to centre of next bed)
    • 2.5 metres (edge of bed to edge of next bed).
  6. In general wards, at least one dedicated handwash basin should be provided:
    • For every bed
    • For every two beds
    • For every four beds
    • For every six beds.
  7. The common route/s for infection transmission in clinics include:
    • Respiratory
    • Respiratory and contact
    • Faeco-oral
    • Inoculation.
  8. The highest risk of infection in dental clinics is from:
    • Blood-borne viruses
    • Bacteria
    • Gastro-intestinal viruses
    • Prions.
  9. Isolation rooms:
    • Should make up at least 30% of all hospital beds
    • Should always be mechanically ventilated under positive pressure
    • Do not need en suite bathrooms
    • Function to separate infectious patients from susceptible patients.
  10. Operating theatres:
    • Should be mechanically ventilated under negative pressure
    • Should be kept at temperatures between 24 and 28 °C
    • May routinely sterilize their own surgical equipment in the theatre
    • Should have well-demarcated ‘clean’ and ‘sterile’ zones.
  11. Intensive care units (ICU):
    • Do not require isolation rooms as the beds are far apart
    • Should have a minimum of 2.5 metres space between beds
    • Require at least one handwash basin for every six ICU beds
    • Should regularly train their staff on hand hygiene and aseptic technique.
  12. Accident and emergency units:
    • Do not require isolation rooms/bays
    • Should have sharps containers within easy reach of every bed/bay
    • Must have negative pressure ventilation
    • Are not high-risk areas for needlestick injuries.
  13. Patients in burns wards:
    • Are not at particularly high risk of infection
    • Acquire infections mostly by respiratory transmission
    • Acquire infections by contact with staff, equipment and the environment
    • Should all be placed under protective isolation.
  14. Neonatal wards require:
    • One isolation room for every 30 beds
    • Disease screening protocols for mothers admitted to kangaroo care units
    • Handwash basins next to every cot/incubator
    • Specialised environmental disinfection of all surfaces.
  15. Milk preparation areas:
    • Are a high-risk area for microbial contamination of infant feeds
    • Can store milk in fridges together with medication and foodstuffs
    • Can prepare feeds up to 48 hours in advance
    • Can use low-level disinfection for babies’ bottles and teats.
  16. With regard to expressed breastmilk (EBM):
    • The risk of HIV or hepatitis transmission through breastmilk is low
    • Mothers may express, label and store the EBM themselves
    • EBM should be stored at 4–6 °C and used within 24 hours
    • Pasteurisation is not needed for pooled EBM.
  17. Mortuary workers:
    • Do not require personal protective equipment since corpses do not transmit infections
    • Are at risk of penetrating injuries, mucosal splashes and infection with respiratory pathogens
    • Are not required to change out of their personal clothing before coming on duty
    • Are not required to shower before coming off duty.
  18. Ambulance staff:
    • Should try to establish any infection transmission hazards before transporting a patient
    • Should wear surgical masks when transporting patients with pulmonary TB
    • Should ask patients with pulmonary TB to wear N95 respirators when inside the ambulance
    • May use alcohol handrub to decontaminate hands covered in blood or mucus.
  19. Hospital kitchens:
    • Staff require only routine pre-employment health checks
    • Require the same personal protective equipment as the clinical staff
    • May prepare raw and cooked food in the same area
    • Require an uninterrupted supply of hot and cold water.
  20. Support services staff:
    • Are at lower risk for pathogen exposure than clinical staff
    • Should receive pre-employment hepatitis B immunisation
    • Are not required to wear personal protective equipment
    • Are not required to undergo training in infection prevention and control.