December 7, 2022

Microorganisms, Sterilization, and Disinfection

Question 1

Non-pathogenic microorganisms are microscopic agents that do not cause disease or infection. While many of them are bacteria, they can also be viruses and fungi. Unlike pathogens, which carry disease, these microorganisms either have no effect on the host or are actually integral to the host’s survival. But non-pathogenic bacteria can sometimes become pathogenic, like in the case of E. coli. Escherichia coli, which is ordinarily found in the human body’s intestines, can also be pathogenic and cause a wide range of human diseases, from watery diarrhea to life-threatening illness.

Per this analysis, what’s the best possible reason for eliminating all microorganisms from a medical environment?

Vulnerable patients shouldn’t be exposed to patients with e. coli

E. coli can be both pathogenic and non-pathogenic

Non-pathogenic microorganisms can turn into pathogens

Pathogenic and non-pathogenic microorganisms can cause disease

Question 2

Pathogens come in all shapes and sizes. Pathogenic microorganisms are carriers of disease and infection, and they fall into one of four categories: fungi, bacteria, viruses, and parasites. Pathogenic fungi are often yeast or mold, and viruses infect the cells of a living host. Pathogenic parasites are often protozoa or protists, and bacteria are numerous—and everywhere.

As a medical professional, you’ll need to understand the breadth and depth of the pathogenic world. Pathogens are dangerous for everyone, but particularly for vulnerable populations, like those in a medical facility. And contamination is a high risk in these settings, threatening all people involved.

When a patient or employee contracts a sickness at a healthcare facility, that sickness is called a healthcare-associated infection (HAI), or a nosocomial infection. Which of the following situations most likely fall into this category? Select all that apply.

A patient gets a herpes virus outbreak while at the hospital.

A healthcare worker gets a hepatitis virus due to mishandling of needles.

A healthcare worker gets a cold from treating a patient.

A patient gets sick due to exposure to a drug-resistant bacterium in a hospital.

Question 3

Many pathogenic microorganisms are bacteria. And in medical environments, bacteria proliferate. Klebsiella bacteria, most often the pneumoniae species, can cause urinary tract infections, wound infections, upper respiratory tract infections, osteomyelitis, and even meningitis. These infections can occur in all healthcare settings, but the risk of infection is increased if a patient requires invasive medical devices, urinary catheters, or ventilators.

As you’ll recall, the 6 “links” in the chain of infection are the infectious microorganism, the reservoir or location where the microorganism lives, the port of exit from the reservoir, the mode of transmission from the reservoir to the host, the portal of entry into the person or host, and the host themselves.

If you had a patient with a urinary catheter, you would have to take specific steps to prevent infection. Which of the following would be the best and safest way or ways to interrupt the chain of infection for Klebsiella bacteria in this case? Select all that apply.

Removing the catheter as needed to prevent port of entry

Controlling aerosols to prevent port of exit

Administering antibiotics preemptively to block the mode of transmission

Administering an immunization to address the infectious agent

Question 4

MRSA, methicillin-resistant Staphylococcus aureus, is a pathogenic bacteria. But it’s more threatening than most bacteria because it is resistant to an entire class of penicillin-like antibiotics, including penicillin, amoxicillin, oxacillin, methicillin, and others. In healthcare facilities, it is usually spread by direct contact with an infected wound or contaminated hands—typically those of healthcare providers. Also, people who carry MRSA but do not have signs of infection can spread the bacteria to others. And surprisingly, experts say MRSA now contributes to more US deaths than does HIV.

In medical settings, it’s vital that healthcare professionals work to prevent the spread of MRSA. Which of the following interventions could interrupt the chain of infection or protect further drug-resistant pathogens from developing? Select all that apply.

Resources and References

Association of Medical Ultrasound Alum (2018, November 3). Guidelines for cleaning and preparing external and internal use ultrasound transducers between patients, safe handling, and use of ultrasound coupling gel. American Institute of Ultrasound in Medicine. Retrieved from https://www.aium.org/accreditation/Guidelines_Cleaning_Preparing.pdf (Links to an external site.)

Performing hand hygiene to decontaminate the hands of healthcare workers

Antimicrobial stewardship to educate medical professionals of the dangers of overprescribing antibiotics

Conducting food safety to interrupt mode of transmission

Administering immunizations to protect patients and healthcare workers from infection

Question 5

Performing hand hygiene is a critical step in maintaining antiseptic healthcare facilities. It’s methodical and systematic, and it requires very specific steps and procedures. There are also several types of handwashes, which can be applied to different situations depending on the level of asepsis required. The objective of a regular handwash is to clean off organic material that is visibly present on hands. An alcohol-based rub, on the other hand, is a quicker and easier approach when the hands are not soiled, and a surgical or aseptic handwash requires the use of antimicrobial soap and a very specific technique.

You’re a medical assistant at a clinic. You’re preparing to see a pediatric patient who has come in for a routine well check-up. However, you notice that he has a slight cough when you see him with his mother in the waiting room. Immediately before calling him in to take his vitals, you fill out some forms for another patient. Which handwash would be best for this type of situation?

Soap and water handwash

Alcohol-based rub

Antiseptic handwash

Intensive handwash

Question 6

The skin is a major source of contamination that cannot be sterilized. So, specific handwashing techniques must be used to significantly reduce the number of bacteria on the hands and arms before sterile gloves are put on. A soap and water handwash is used often in medical settings, and it should always be utilized when dirt or organic material is visibly present on hands.

There are several important steps in conducting this handwash. Jewelry must be removed, and ample soap must be lathered on. Hands must be rubbed together for at least 15 seconds, and each finger must be rubbed individually. The wrists must also be cleaned thoroughly.

However, this handwash is still insufficient for several procedures, including surgery. For those, an antiseptic handwash is necessary. What’s the difference?

Antiseptic handwash requires cleaning under the nails

Antiseptic handwash doesn’t require that jewelry be removed

Antiseptic handwash has a longer handwash with regular soap

Antiseptic handwash uses antimicrobial soap

Question 7

According to the Centers for Disease Control and Prevention, sterilization is a process that eliminates all forms of microbial life and is used in healthcare facilities. Sterilization can occur both by physical or chemical methods. Disinfection is different than sterilization because it does not remove bacterial spores or inanimate objects.

What are the negative consequences associated with using sterilization and disinfection interchangeably? Select all that apply.

Resources and References

Rutala, W.A., Weber, D. J., & HICPAC. (2008). Guideline for disinfection and sterilization in healthcare facilities, 2008. CDC. Retrieved from https://www.in.gov/isdh/files/Tab_1_Resource_CD.pdf (Links to an external site.)

Delivery rooms could be cleaned improperly

Devices could be cleaned improperly

Pathogens could be present in aseptic fields

Sterile instruments could touch non-sterile instruments

Question 8

Steam sterilization—also known as autoclaving because it’s performed in an autoclave—is arguably the most used and most reliable form of sterilization. Direct steam exposure helps kill microorganisms, and according to the Centers for Disease Control and Prevention, pressure serves as a means to obtain the high temperatures necessary to kill microorganisms. The minimum exposure time for periods for sterilization of wrapped healthcare supplies is 30 minutes at 121°C (250°F) in a gravity displacement sterilizer or 4 minutes at 132°C (270°F) in a prevacuum sterilizer.

What are the primary factors that need to be considered in steam sterilization? Select all that apply.

Resources and References

Steam

Heat

Pressure

Time

Question 9

Ethylene Oxide, or ETO, is a flammable and explosive gas that is used to sterilize devices. It is more dangerous and costly than steam, but through its chemical reactions prevents normal cellular metabolism and replication in microorganisms.

According to the Centers for Disease Control and Prevention, because ETO is absorbed by many materials, sterilization of the item must undergo aeration. Guidelines on how long the item should be promulgated depends on what the device is, how often, and how long the device is used.

Despite the risks and costs involved, healthcare facilities use ETO for sterilization purposes. What might those be?

References and Resources

To disinfect instruments that are expensive to replace

To sterilize instruments that cannot withstand heat or moisture

To disinfect instruments that cannot withstand heat or moisture

To sterilize instruments that resist ETO

Question 10

Disinfection is a process that eliminates many or all pathogenic microorganisms specifically. However, it doesn’t kill all microbes, such as bacterial spores, and therefore is used in situations in which it’s not critical that the environment or equipment be entirely free of microorganisms. But it still dramatically reduces the likelihood of contamination.

According to the Centers for Disease Control and Prevention, disinfections are not sporicidal. Chemical sealants can kill spores for prolonged exposure times (3-12hours). There are three levels of disinfectants – high-level, low-level, and intermediate-level. High-level disinfectants with concentrations similar to chemicals sealant but with shorter exposure periods are able to kill all microorganisms except large numbers of bacterial spores. Low-level disinfectants can kill most vegetative bacteria, some fungi, and some viruses in a practical period of time (≤10 minutes). Intermediate-level disinfectants might be cidal for mycobacteria, vegetative bacteria, most viruses, and most fungi but do not necessarily kill bacterial spores

You’re a medical assistant working in a clinic, and you’re asked to disinfect the handrail in the hallway. What type of disinfectant might you use for this type of housekeeping? Select all that apply.

Resources and References

Chemical sterilants

High-level disinfectants

Intermediate-level disinfectants

Low-level disinfectants

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Microorganisms, Sterilization, and Disinfection

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