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Test 6: Environmental cleaning, waste management and decontamination of medical devices

  1. Infection can be easily transmitted from:
    • Inadequately cleaned healthcare environments
    • Properly sterilized medical instruments
    • Clean and dry surfaces
    • Single-use medical devices.
  2. Environmental surfaces in healthcare facilities should be:
    • Carpeted to reduce the noise levels.
    • Non-compatible with hospital detergents and disinfectants
    • Rough and porous
    • Easy to clean.
  3. Domestic or cleaning staff:
    • Require appropriate personal protective equipment (PPE) suitable for their work
    • Require immunisation against meningitis
    • Do not need to undergo IPC training
    • Are not at risk of acquiring infections from patients.
  4. Regarding frequently touched areas:
    • Micro-organisms are easily transferred from people’s hands to surfaces
    • The closer the surface to the patient, the lower the chance of pathogen transfer to the patient
    • No special attention should be paid when cleaning these areas
    • Surfaces get wiped clean by those that touch them.
  5. Terminal room cleaning is required for patients with:
    • A community-acquired pneumonia
    • Pulmonary mycobacterium tuberculosis (PTB)
    • A myocardial infarction
    • A fungal toe-nail infection.
  6. The terminal cleaning process requires:
    • Routine cleaning of the room
    • Re-carpeting or re-tiling of the room
    • Repainting of the room
    • Removal of all linen, consumables and PPE plus cleaning, wiping down with disinfectant.
  7. Accidents and blood spills should be handled as follows:
    • A written procedure should be available for management of accidents and spills
    • Personal protective equipment is not needed when cleaning spills
    • Blood spills should be wiped over with chlorine at concentration 100 parts per million
    • Chlorine should be applied directly to the spill so as to avoid touching the surface.
  8. Training in healthcare waste management should be provided to:
    • Cleaners/domestic staff
    • Radiographers
    • Pharmacists
    • All healthcare facility staff.
  9. Effective management of clinical waste involves:
    • Source segregation of waste into robust, colour-coded plastic bags
    • A waste storage area that is accessible to all staff and visitors
    • Incineration of all types of waste
    • Highly mechanised systems of moving clinical waste from point of generation to disposal.
  10. There is a high risk of sharps or needlestick injury to staff when:
    • Sharps containers are mounted on the wall
    • Puncture-proof containers are used
    • Sharps containers are filled higher than indicated two-thirds full mark
    • Sharps containers are located within easy reach of the clinician.
  11. The cleaning process for reprocessing used medical devices:
    • Physically removes soil and organic matter, with bacteria and viruses
    • Kills and destroys almost all pathogens
    • Is capable of killing spores
    • Is capable of killing prions.
  12. According to the Spaulding classification:
    • Endoscopes are critical devices
    • Surgical instruments are critical devices
    • Blood pressure cuffs and stethoscopes are semi-critical devices
    • The operating theatre floor is seen as semi-critical.
  13. When processing medical devices:
    • The device can be reliably disinfected without needing prior cleaning
    • Devices should be soaked to allow the disinfectant to penetrate organic matter
    • Soaking gives a sense of security that the item is safe to re-use
    • Cleaning must precede any other step of reprocessing.
  14. Cleaning of medical devices:
    • Does not require wearing of any personal protective equipment (PPE)
    • Can be effective without the need to disassemble equipment
    • Should be done with a soft nylon brush to scrub the device below the water level
    • Involves leaving the cleaned device soaking in water until needed for use on a patient.
  15. Disinfection of medical devices:
    • Destroys all micro-organisms
    • Is best achieved using chemical disinfectants
    • Eliminates the need for prior cleaning of devices
    • Reduces pathogens to levels not harmful to health.
  16. Disinfectants:
    • Both alcohol and chlorine disinfectants are effective at killing Clostridium difficile
    • Are used for killing pathogens on live tissue
    • Act rapidly to kill pathogens
    • Have no known side-effects.
  17. The ideal disinfectant should:
    • Leave a visible mark to show it has worked
    • Have a rapid onset of action
    • Be safe for use on live tissue
    • Be corrosive to surfaces.
  18. The sterile services department (SSD) should:
    • Process all critical and semi-critical items in a hospital
    • Have a single large room where ‘clean’ and ‘dirty’ instruments are processed
    • Be operated by cleaners in the wash room
    • Routinely allow operating theatre staff to process instruments in the surgical area.
  19. An advantage of autoclave sterilizers is:
    • They do not require trained staff to operate
    • They can be used for all medical devices
    • They are cheaper to purchase than disinfectants
    • They have a rapid process leaving no toxic residue.
  20. Validation of autoclave sterilizers uses:
    • The Bart Dickson test
    • Swabbing the instruments for bacterial contamination
    • Visual inspection for cleanliness of the instruments
    • Physical, biological and chemical indicators.