Infection Control and Respiratory Therapy Quiz

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Questions and Answers

What is the primary function of Heat Moisture Exchanger Filters (HMEF)?

  • To filter out large particulates only
  • To capture viral particles effectively
  • To conserve heat and moisture (correct)
  • To increase the tidal volume delivered

Which particle size is SARS-CoV-2 associated with?

  • 0.125 micron (correct)
  • 0.01 micron
  • 0.3 micron
  • 1 micron

What could be a contraindication for using HEPA filters?

  • Patients with normal tidal volumes
  • Patients with thin secretions
  • Patients with mild bronchospasm
  • Patients with bloody or thick secretions (correct)

Which standards must efficient filters comply with?

<p>ISO 23328-1 and ISO 9360-1 (C)</p> Signup and view all the answers

What is a potential effect of not humidifying air during respiratory therapy?

<p>Hypothermia and airway epithelium disruption (A)</p> Signup and view all the answers

What is the primary benefit of using automated dispensing machines in pharmacies?

<p>They reduce pharmacists’ dispensing time. (B)</p> Signup and view all the answers

What role do aprons play in infection control for healthcare workers?

<p>They protect healthcare workers from contamination. (B)</p> Signup and view all the answers

Why are sterile gloves important during intravenous drug administration?

<p>They protect key sites from microbial contamination. (A)</p> Signup and view all the answers

What is one consequence of poor aseptic technique during invasive procedures?

<p>Increased risk of healthcare-associated infections. (B)</p> Signup and view all the answers

How do cleaning procedures for equipment help in infection control?

<p>They reduce microbial contamination. (D)</p> Signup and view all the answers

What is the primary purpose of non-sterile gloves in healthcare settings?

<p>To prevent contamination from blood and body fluids. (B)</p> Signup and view all the answers

What aspect of infection control does good inventory management in pharmacies affect?

<p>The safety during medication preparation. (A)</p> Signup and view all the answers

Which of the following is a key consideration in aseptic technique during intravenous medication administration?

<p>Ensuring equipment is sterile. (B)</p> Signup and view all the answers

What percentage of heat and moisture is supplied to the alveoli during invasive mechanical ventilation through the upper airway?

<p>75% (D)</p> Signup and view all the answers

Why is it prohibited to place an HME filter between the circuit and the soda lime absorber?

<p>It poses a risk of biohazards due to absorber systems. (C)</p> Signup and view all the answers

What is Compound A, as mentioned in the content?

<p>A product formed when sevoflurane interacts with strong bases. (A)</p> Signup and view all the answers

What is the significance of using HEPA filters over electrostatic filters?

<p>HEPA filters maintain effectiveness in wet conditions. (A)</p> Signup and view all the answers

What should be done with antiviral and antibacterial filters?

<p>They must be positioned between the breathing circuit and the expiratory hose. (A)</p> Signup and view all the answers

What risk is associated with barium hydroxide lime when used with sevoflurane?

<p>Formation of toxic metabolites. (A)</p> Signup and view all the answers

What is a primary consideration when connecting the ventilator to the inspiratory hose?

<p>Preventing pathogens from reaching the anesthesia machine. (C)</p> Signup and view all the answers

What is one concern regarding the accumulation of carbon monoxide in a breathing circuit?

<p>It can lead to toxic effects. (B)</p> Signup and view all the answers

What is the primary function of the cuff pressure gauge?

<p>To display the cuff pressure of endotracheal tubes (B)</p> Signup and view all the answers

What does the presence of a bubbling sound during cuff inflation indicate?

<p>There is a leak around the ETT cuff (A)</p> Signup and view all the answers

What is the recommended method to check for leaks in the ETT cuff?

<p>Listening for sounds of air leakage and adjusting accordingly (A)</p> Signup and view all the answers

What is a potential complication of using the cuff pressure gauge incorrectly?

<p>False reading of cuff pressure (B)</p> Signup and view all the answers

What could occur if the cuff is over-deflated?

<p>Loss of PEEP and risk of micro-aspiration (A)</p> Signup and view all the answers

What design feature helps facilitate one-handed operation of the pressure gauge?

<p>Ergonomic design (B)</p> Signup and view all the answers

Which measurement range is typical for cuff pressure gauges?

<p>0–60 cmH2O and 0–120 cmH2O (A)</p> Signup and view all the answers

Why is it important for cuff pressure to be within a specified range?

<p>To prevent complications such as micro-aspiration (C)</p> Signup and view all the answers

What is the primary purpose of HME/filters in relation to the Endotracheal Tube port (ETT)?

<p>To retain exhaled moisture on the patient side (D)</p> Signup and view all the answers

Which type of lamp is mentioned as a commonly used technology for UV irradiation?

<p>Pulsed xenon lamps (A)</p> Signup and view all the answers

What effect does placing an HME/filter in a distal position on the inspiratory hose have?

<p>It decreases inhaled gas temperature and humidity (B)</p> Signup and view all the answers

Why is UVGI considered a cost-effective method for reducing microbial contamination in operating theatres?

<p>It is less expensive than laminar air systems (A)</p> Signup and view all the answers

What factor greatly influences the efficacy of UV disinfection?

<p>The distance between the light source and surface (C)</p> Signup and view all the answers

Which component is critical for ensuring an effective humidification process during anesthesia?

<p>Proper placement of HME/filters (A)</p> Signup and view all the answers

How is the microbial contamination reduction achieved by UVGI compared to laminar airflow systems?

<p>UVGI is equally efficient but cheaper (C)</p> Signup and view all the answers

What happens to the humidity and temperature of inspired gases when an HME is improperly placed?

<p>They both decrease (C)</p> Signup and view all the answers

Which is NOT a characteristic of UV irradiation used in operating theatres?

<p>It uses visible light (C)</p> Signup and view all the answers

What is a potential consequence of using a poorly positioned HME/filter?

<p>Increased risk of contamination (C)</p> Signup and view all the answers

What is a primary disadvantage of Mapleson circuits?

<p>High fresh gas flow requirement (A)</p> Signup and view all the answers

Which Mapleson circuit is named the Bain circuit?

<p>Mapleson D (B)</p> Signup and view all the answers

What is the required fresh gas flow for normocarbia during spontaneous ventilation?

<p>200-300 mL/kg/min (C)</p> Signup and view all the answers

What characteristic of closed breathing systems ensures the correct volume of gases is maintained?

<p>Closed discharge valve (D)</p> Signup and view all the answers

Which of the following is NOT a disadvantage of Mapleson circuits?

<p>Low cost (D)</p> Signup and view all the answers

What is the primary function of a bacteria filter in Mapleson circuits?

<p>To prevent contamination (D)</p> Signup and view all the answers

What is the name of Mapleson A circuit?

<p>Magill circuit (D)</p> Signup and view all the answers

Which Mapleson circuit provides minimal dead space and resistance during controlled ventilation?

<p>Mapleson D (D)</p> Signup and view all the answers

Flashcards

Automated dispensing machines

Automated dispensing machines help manage drug inventory by automatically refilling when supplies reach a predetermined minimum level. This process reduces pharmacists' dispensing time and relies on pharmacy technicians to handle inventory.

How to reduce microbial contamination during drug preparation?

Cleaning pharmacy equipment, such as trolleys and trays, reduces the risk of microbial contamination during drug preparation.

Why is preparation of equipment important for sterile drug administration?

Sterile equipment must be carefully prepared to ensure they remain free of microbial contamination. This is crucial for preventing infection during medication administration.

What is the purpose of aprons in sterile drug preparation?

Aprons used by healthcare workers during drug preparation provide a barrier against potential contamination from both the worker and the procedure. This helps protect both the worker and the patient.

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Why are non-sterile gloves used during drug preparation?

Non-sterile gloves protect healthcare workers from potential contamination from blood or bodily fluids during drug preparation.

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What is the purpose of sterile gloves in sterile drug preparation?

Sterile gloves are worn to prevent microbial contamination of key sites during drug preparation. This ensures the medication is free from contaminants before administration.

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Aseptic techniques in IV drug administration

Intravenous drug administration, while a common practice, carries a risk of infection. Following aseptic techniques during preparation and administration helps reduce this risk.

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Healthcare-associated infections (HAIs)

Healthcare-associated infections (HAIs) are infections contracted in a healthcare setting. These infections can be caused by various factors, including invasive procedures and inadequate infection control measures.

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Cuff Pressure Gauge

A device used to measure the pressure in an endotracheal tube (ETT) cuff, ensuring proper inflation and preventing complications.

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ETT Cuff

A small, inflatable balloon attached to the endotracheal tube that seals the airway around the tube.

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Luer Attachment

A connection point on the cuff pressure gauge that allows attachment to a pilot balloon, which inflates the cuff.

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Rubber Hand Bulb

A hand-operated bulb used to inflate the ETT cuff.

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Pressure Release Valve

Allows gradual release of air from the ETT cuff, reducing pressure.

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Pressure Display Gauge

Visual indicator on the cuff pressure gauge that shows the pressure level in the cuff.

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Recommended Pressure Limits

The recommended pressure range for the ETT cuff, displayed on the gauge as a colored wedge.

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Minimal Leak Technique

The process of inflating the ETT cuff to create a seal, while checking for air leaks and adjusting pressure to stay within safe limits.

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Heat Moisture Exchanger Filters (HMEF)

Filters that capture heat and moisture exhaled by the patient, like a mini-humidifier.

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HEPA filters

Filters that capture particles, including viruses, bacteria, and dust, but not heat or moisture.

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Viral Filtration Efficiency (VFE)

A measure of how well a filter captures particles in the air. A higher VFE means the filter is more efficient.

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Hypothermia

A condition where the patient's airways become dry due to loss of moisture during breathing. This can lead to discomfort and potential complications.

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Contraindications

These are conditions that prevent or make it unwise to use a particular treatment or procedure.

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Upper airways' role in humidification

The upper airways contribute significantly to humidifying inhaled air during mechanical ventilation, providing 75% of the moisture.

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Why use an HME (heat and moisture exchanger)?

Using a humidifier, like an HME, within the breathing circuit can help replicate the normal humidification process. It's crucial for maintaining healthy airways and preventing complications like mucus build-up.

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HME position in breathing circuit

It's incorrect to place an HME filter between the breathing circuit and the soda lime absorber because it increases the risk of hazardous compounds like carbon monoxide building up.

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HME on inspiratory hose

Using an HME filter directly on the inspiratory hose can be challenging since it makes it harder for air to be drawn into the lungs.

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Compound A formation

Strong bases in soda lime can react with certain anesthetic gases, like sevoflurane, creating potentially harmful byproducts.

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Why use filters during mechanical ventilation?

Because filters trap pathogens, they are highly recommended to prevent the spread of infection. It's crucial to use HEPA filters as they are effective in both wet and dry conditions.

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HEPA filters vs electrostatic filters

HEPA filters offer better protection against airborne particles compared to electrostatic filters when they get wet.

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Filter position in breathing circuit

Filters should be placed between the breathing circuit and the expiratory hose to act as a barrier against pathogens when the breathing circuit is disconnected.

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Mapleson A Circuit

A type of breathing circuit that requires a high fresh gas flow to prevent rebreathing. It's named after the English physician Magill.

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Mapleson C Circuit

This circuit is named after Dr. Waters and is known for its 'to and fro' movement of gases. It's a simple and lightweight circuit but requires a high fresh gas flow.

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Mapleson D Circuit

Known as the Bain circuit, this is a coaxial system with the fresh gas inlet inside the breathing tube and exhalation through the outer tube. Requires a moderate fresh gas flow for spontaneous ventilation.

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Mapleson E Circuit

A simple T-piece system named after Dr. Ayre's. Requires a high fresh gas flow for controlled ventilation, as rebreathing is a concern.

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Mapleson F Circuit

A modification of the Mapleson A circuit, with minimal dead space and low resistance to breathing. However, it still requires a high fresh gas flow and has limitations for controlled ventilation.

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Closed Breathing System

A breathing system where the volume of fresh gases delivered into the system is equal to the volume received by the patient. The exhaled gas, after CO2 absorption, is entirely recycled back to the patient.

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Humidity Reduction in Breathing Circuits

Using high fresh gas flow (greater than 5L/min) helps to minimize heat and moisture loss during anesthesia. It's like flushing out the system with fresh air.

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Waste Gas Excretion in Breathing Circuits

A system's ability to remove waste gases from the breathing circuit is crucial to prevent anesthetic agent buildup in the operating room. Insufficient waste gas excretion can lead to a high concentration of anesthetic in the room.

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HME/Filter placement for ETT

Heat and Moisture Exchanger (HME) or filter designed to retain moisture from exhaled breath on the patient side. It improves patient humidification when placed directly in contact with the endotracheal tube (ETT) port.

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Why is HME placement important?

This assembly prevents contamination of the gas measurement unit and the entire anesthesia system by ensuring moisture from the patient's breath is retained.

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What is UVGI?

Ultraviolet Germicidal Irradiation (UVGI) is a method to reduce microbial contamination in operating rooms (OR) by using UV light. It is more cost-effective than laminar airflow systems.

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Types of UVGI Lamps

Low-pressure mercury lamps and pulsed xenon lamps are commonly used UVGI technologies.

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UVGI Effectiveness

The effectiveness of UV disinfection depends on the distance between the light source and the surface being disinfected. The closer the light source, the stronger the effect.

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Semi-closed breathing system

A breathing system that limits the amount of fresh gas used, while exhaled gases are recycled back to the patient, allowing for conservation of anesthetic agents.

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Anesthesia Machine Calibration

The process of ensuring a medical device functions within its specified parameters and is safe to use.

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Anesthesia Machine Checklist

A list of checks performed on an anesthesia machine before use to ensure safety and proper function.

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Checking Oxygen Cylinder

Regularly checking the oxygen cylinder, including its pressure level, ensures a sufficient supply is available during surgery.

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Study Notes

Pharmacology of Anesthesia

  • General anesthesia (GA) is commonly used for major surgeries; a reversible state characterized by hypnosis, amnesia, analgesia, and muscle relaxation
  • GA induction can be achieved using IV and/or inhalation agents, and adjunct IV agents (e.g., opioids, benzodiazepines), and neuromuscular blocking agents (NMBAs), which is used for endotracheal intubation.
  • GA maintenance involves using primary inhalation techniques, Total Intravenous Anesthesia (TIVA), or a combination of both IV and inhalation agents to sustain the anesthetic. This aims to minimize the total dose of any one agent used
  • Stage I (Analgesia): patients feel no pain yet remain conscious
  • Stage II (Excitement): delirium or violence may occur as blood pressure drops and respiratory rate increases. Barbiturates usually bypass this stage.
  • Stage III (Surgical Anesthesia): skeletal muscles relax and breathing becomes regular; eye movements slow and stop, enabling surgery
  • Stage IV (Medullary Paralysis): this is undesirable; respiratory centers cease operation potentially resulting in death. Careful anesthetic control is crucial to avoid this stage
  • Emergence: return to consciousness and movement; usually spontaneous ventilation allows extubation without assistance

Types of Medication in Anesthesia

  • Induction medications: produce and maintain unconsciousness, including IV and volatile agents
  • Analgesics: provide pain relief
  • Muscle relaxants: induce muscle relaxation
  • Other frequently used medications: include medications that minimize nausea and vomiting (antiemetics), counteract effects of other medications (antagonists), suppress/stimulate nervous reflexes (e.g., sympathetic and parasympathetic modulation)

Essential Introduction to Pharmacology

  • Pharmacokinetics (PK) studies how the body acts upon a drug. This consists of phases:
    • Absorption: the entry of a drug into the body (e.g., oral, transdermal, rectal, etc.)
    • Distribution: drug dispersion within the body (e.g., based on lipid solubility)
    • Metabolism: how the body changes the drug (e.g., in the liver)
    • Excretion: removal of the drug from the body (e.g., through urine or bile)
  • Pharmacodynamics (PD) studies how the drug acts on the body. This is classified into three actions:
    • Depending on the physical properties of the medication
    • Binding to specific receptors to provide an effect
    • Binding to specific enzymes to inhibit/decrease their activity

Induction Medications

  • Intravenous induction agents: thiopentone, etomidate, ketamine, propofol
  • General speaking: intravenous drugs or inhalation agents

Intravenous Anesthetics

  • Thiopentone sodium (Thiopental, also known as Sodium Thiopental)
  • Fig. 3.1a: Form: Injection, 0.5-g and 1-g vials
  • Uses: inducing anesthesia before administering inhalational anesthetics, short-term anesthesia
  • Contraindications: inability to maintain airway, cardiovascular disease, dyspnea, or obstructive respiratory disease, hypersensitivity to barbiturates; porphyria

Analgesics and Opioids

  • Opioid analgesics (morphine, fentanyl, remifentanil) are used to supplement general anesthesia.
  • Repeated doses need careful control as respiratory depression may persist after surgery

Muscle Relaxants and Cholinesterase Inhibitors

  • Skeletal muscle relaxants are categorized into depolarizing (e.g., succinylcholine) and non-depolarizing (e.g., vecuronium, pancuronium, rocuronium, mivacurium, and cisatracurium) types.
  • Important for: laryngoscopy, rapid sequence intubation, and emergency cases
  • Succinylcholine (Suxamethonium) is a very short-acting depolarizing agent.
  • Rocuronium bromide is an intermediate-acting non-depolarizing agent, useful for rapid sequence intubation and surgeries
  • Pancuronium bromide is a long-acting non-depolarizing agent, used during intubation
  • Atracurium is a medium-acting non-depolarizing agent

Reversal of Neuromuscular Block

  • Cholinesterase inhibitors (e.g., neostigmine methylsulfate): used to reverse the effects of muscle relaxants

Drug Handling

  • Medication errors are a concern in anesthetic practices; standardization of anesthesia drug trays is helpful to minimize errors by using prefilled syringes in a standardized color-coded storage system, bar-code readers, large labels, etc.

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