infection control case study quizlet

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• Published: 28 March 2019

Scenario-based simulation training for the WHO hand hygiene self-assessment framework

• Ermira Tartari 1 , 2 , 3 ,
• Carolina Fankhauser 1 ,
• Alexandra Peters 1 ,
• Buyiswa Lizzie Sithole 1 , 4 ,
• Funda Timurkaynak 1 ,
• Sarah Masson-Roy 1 ,
• Benedetta Allegranzi 5 ,
• Daniela Pires 1 , 6 &
• Didier Pittet 1  

Antimicrobial Resistance & Infection Control volume  8 , Article number:  58 ( 2019 ) Cite this article

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The WHO SAVE LIVES: Clean Your Hands global hand hygiene campaign, launched in 2009 and celebrated annually on the 5th of May, features specific calls to action seeking to increase engagement from stakeholders’ collaborations in hand hygiene improvement. WHO calls on everyone to be inspired by the global movement towards universal health coverage (UHC). Infection prevention and control (IPC), including hand hygiene, is critical to achieve UHC as it has a direct impact on quality of care and patient safety across all levels of the health services. In the framework of UHC, the theme for 5 May 2019 is “Clean care for all – it’s in your hands”. In this context, the WHO has launched a global survey to assess the current level of progress of IPC programmes and hand hygiene activities in healthcare facilities (HCFs) worldwide. This involved the creation of two tools for healthcare facilities: the WHO Infection Prevention and Control Assessment Framework (IPCAF) and the WHO Hand Hygiene Self-Assessment Framework (HHSAF). The objective of this paper is to provide case scenario-based simulation for IPC specialists to simulate and fully assimilate the correct completion of the HHSAF framework in a standardized format. The three case scenarios have been tested and are proposed for the reader to assess the HHSAF of different HCFs in a variety of contexts, even in low-resouce settings. They were designed for simulation training purposes to achieve standardization and interactive learning. These scenarios are meant to be used by professionals in charge of implementing a hand hygiene improvement strategy within their HCF, as well as for simulation and standardized training purposes prior to completing and submitting data for the 2019 WHO Global Survey. Additionally, information provided by the use of the HHSAF can easily be translated into action plans to support the implementation and improvement related to specific indicators of hand hygiene promotion. We invite all HCFs to participate in the 2019 WHO global survey and monitor the level of progress of their IPC programme and hand hygiene activities.

Too many of the vulnerable individuals admitted to health-care settings develop a health-care associated infection (HAI). This results in increased morbidity and mortality, prolonged hospital stay, and financial losses for health care systems [ 1 , 2 ]. Additionally, prevention of transmission and control of multidrug-resistant organisms in health care settings are critical as the number of antibiotics available to treat these infections is limited [ 3 ]. Many of these issues could be prevented through simple, low-cost infection prevention and control (IPC) measures such as hand hygiene performed at critical moments [ 4 , 5 ].

The focus of the World Health Organization (WHO) SAVE LIVES: Clean Your Hands global campaign has been to promote best hand hygiene practices as a key component of achieving quality of care and patient safety [ 6 , 7 , 8 , 9 , 10 , 11 ]. This campaign, launched in 2009 and celebrated annually on the 5th of May, features specific calls to action each year, and seeks to increase engagement from stakeholders’ collaborations in strenghtening IPC programmes and improving hand hygiene. This year’s campaign theme is “Clean care for all – it’s in your hands” [ 11 ] ( https://www.who.int/infection-prevention/campaigns/clean-hands/en/ ).

‘Health for All’ has been increasingly recognized in international fora as a concept firmly based on equity. Alongside a strong global momentum surrounding universal health coverage (UHC), WHO calls on everyone to contribute to the attainment of health for all populations [ 12 ]. In the context of UHC, IPC with hand hygiene as a fundamental measure, is a key component in providing patient safety and high quality health services [ 12 , 13 ].

The 2019 WHO global survey

The WHO global survey aims to assess the current level of progress of IPC programmes and hand hygiene activities in HCFs in the context of the WHO SAVE LIVES: Clean Your Hands annual hand hygiene global campaign ( https://www.who.int/infection-prevention/campaigns/ipc-global-survey-2019/en/ ). The survey will be open until July 2019, and WHO invites all HCFs to join. The survey is based on the use of two tools at the HCF level: the WHO Infection Prevention and Control Assessment Framework (IPCAF) ( https://www.who.int/infection-prevention/tools/core-components/IPCAF-facility.PDF?ua=1 ) and the WHO HHSAF ( https://www.who.int/gpsc/country_work/hhsa_framework_October_2010.pdf?ua=1 ) [ 14 , 15 ]

The IPCAF is a validated assessment tool that supports the implementation of the WHO recommendations on the core components of effective IPC programmes [ 16 ] at the acute HCF level. The goal of the framework is to assess the current IPC situation in HCFs. It is especially focused on evaluating existing IPC activities/resources, and identifying strengths and gaps that can inform future policies. It can be considered as a diagnostic tool for HCFs to detect relevant problems or shortcomings that require improvement as well as identify areas where international standards and requirements can be met [ 16 , 17 ].

The HHSAF is a systematic tool with which an individual health-care facility can obtain a situational analysis of its hand hygiene promotion and practices [ 14 , 15 ]. To guide future improvement WHO is launching the HHSAF again in 2019 as part of the WHO global survey (the HHSAF was previously launched in 2011 and 2015) ( https://www.who.int/infection-prevention/campaigns/ipc-global-survey-2019/en/ ).

Assesing the level of hand hygiene at your institution

Measuring, promoting, improving, and subsequently sustaining hand hygiene standards as quality indicators for patient safety is essential [ 18 ]. To advance this agenda, it is crucial to monitor where improvements have occurred and gaps must be addressed in hand hygiene structures, processes, resources, promotion and practices [ 19 , 20 ].

WHO provides a range of tools and resources to sustain hand hygiene improvement. One is the Hand Hygiene Self-Assessment Framework (HHSAF), which is a validated tool used to quantify the status of hand hygiene promotion activities within healthcare facilities worldwide [ 14 , 15 ]. Launched by WHO in 2010, the HHSAF is available in different languages; it remains the most widely used tool and the only framework aimed at tracking the level of progress of healthcare facilties in the context of hand hygiene implementation. Structured around the five components of the WHO Multimodal Hand Hygiene Improvement Strategy (see Appendix ), the HHSAF assesses the interventions implemented by HCFs in the context of their adherence to WHO hand hygiene guidelines and recommendations [ 18 , 19 , 20 ]. The HHSAF analyses a number of factors within each of the five components of the multimodal strategy and scores institutions’ status as inadequate, basic, intermediate and advanced, according to the number of points obtained (see Appendix ). Additionally, it directs HCFs to the WHO hand hygiene promotion tools and the template action plans (available at https://www.who.int/infection-prevention/tools/hand-hygiene/en/ ) that can be used to make improvement plans according to the HHSAF score and specific indicators identified as requiring attention.

Given this important focus on hand hygiene in IPC programmes, the WHO previously conducted two global surveys using the HHSAF in 2011 and 2015, inviting HCFs worldwide to submit their self-assessments [ 21 ]. The two surveys offered a bird’s eye view of hand hygiene programmes at the HCF level and enabled better comparisons across regions and over time, prompting calls for further improvements. In 2011, the majority of HCFs participating were from developed countries and reflected an intermediate level of progress. When the survey was repeated in 2015, the overall score increased significantly ( p  < 0.001) in the 86 HCFs that participated in both surveys [ 21 ]. Improvement was documented in all regions, particularly in the Eastern Mediterranean region, Europe and the Americas. The African region scored lowest, which could be indicative of a poorer IPC infrastructure, resources and basic knowledge in hand hygiene implementation and issues concerning sustainability. The disparities that emerged from the two global HHSAF surveys emphasize the need for additional improvement of hand hygiene practices, especially in low-resource settings.

Supporting hand hygiene education and training

To support education and training activities around the global survey, WHO, together with the WHO Collaborating Centre on Patient Safety, developed a body of material including an educational video (available at https://www.youtube.com/watch?v=PDz8kxrPaMk&feature=youtu.be ), a promotional video (available at https://www.youtube.com/watch?v=UfH6ODLV3BI ) and three case scenario-based simulations (Tables 1 , 2 and 3 ) for IPC specialists to simulate and fully assimilate the correct completion of the HHSAF framework in a standardized format. Simulation in health care is widely used in medical education as an active learning method and it has been shown to have great potential [ 22 , 23 , 24 ].

The case scenarios presented here can be used by professionals in charge of implementing a hand hygiene improvement strategy within their facility, as well as for simulation and standardized training purposes prior to completing and submitting data for the 2009 WHO Global Survey. As proposed by the WHO Guide to Implementation, information provided through the use of the HHSAF should be translated into action plans to support the implementation and improvement related to specific indicators of hand hygiene promotion [ 19 , 20 ]. HCFs worldwide should consider implementing a system of continuous assessment of hand hygiene improvement strategy [ 21 ] by utilizing the HHSAF tool systematically; the current recommendation by WHO and experts is to use it at least annually.

Information appropriate for each of the WHO Multimodal Hand Hygiene Improvement Strategy components has been identified in the case scenarios (Tables 1 , 2 and 3 ). In order to simulate the completion of the HHSAF, they provide details regarding HH promotion strategy for the evaluation of resources, promotion, and practices within a given HCF. The three case scenarios took in consideration a range of HCFs around the world in a variety of contexts, regardless of the resources available. Drawing from the information provided, a score is assigned for each component and section. The sum of the maximum values in each section is 100 points, adding up to a maximum overall score of 500 points. Based on the overall score, a HCF is then assigned to one of four levels of hand hygiene implementation progress (see Appendix ). The HCF presented in Table 1 scored as Advanced , and can therefore undergo further Leadership assessment according to twenty additional criteria, but since only ten of them have been met, the HCF is not classified as having reached the Leadership level. Information for baseline evaluation of hand hygiene activities within a lower income setting is presented in Table 2 ; based on the overall score, the HCF would be assigned as Inadequate level of progress. The HCF in Table 3 is assigned to Basic level, identifying the need for significant improvement. The use of HHSAF over time will enable HCFs to keep track of their progress and continuously set new targets for improvement.

The foremost objective of the WHO global annual campaign is to prioritize IPC in health care and the global health agenda, with hand hygiene assessment and improvement playing a fundamental role in ensuring patient safety. We invite all HCFs to be actively engaged in this important endeavour and call upon all those who can contribute towards achieving high-quality health care and universal health coverage for the improvement of public health worldwide.

“Clean care for all – it’s in your hands”

Abbreviations

Health-care associated infection

Health care facility

Hand Hygiene Self-Assessment Framework

Infection Prevention and Control

Infection Prevention and Control Assessment Framework

Universal Health Coverage

• World Health Organization

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Acknowledgements

We thank healthcare facilities for providing helpful information for the case scenarios.

This work is supported by the World Health Organization (WHO), Geneva, Switzerland, and the Infection Control Programme and WHO Collaborating Centre on Patient Safety (SPCI/WCC), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; hand hygiene research activities at the SPCI/WCC are also supported by the Swiss National Science Foundation (grant no. 32003B_163262).

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Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland

Ermira Tartari, Carolina Fankhauser, Alexandra Peters, Buyiswa Lizzie Sithole, Funda Timurkaynak, Sarah Masson-Roy, Daniela Pires & Didier Pittet

Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland

Ermira Tartari

Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta

Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa

Buyiswa Lizzie Sithole

Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland

Benedetta Allegranzi

Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

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All authors critically reviewed the contents of the manuscript and approved the final version. All authors did final editing and approval.

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All listed authors declare no financial support, grants, financial interests or consultancy that could lead to conflicts of interest. Didier Pittet works with WHO in the context of the WHO initiative ‘Private Organizations for Patient Safety – Hand Hygiene’. The aim of this WHO initiative is to harness industry strengths to align and improve implementation of WHO recommendations for hand hygiene in health care in different parts of the world, including in least developed countries. In this instance, companies/industry with a focus on hand hygiene and infection control related advancement have the specific aim of improving access to affordable hand hygiene products as well as through education and research.

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Tartari, E., Fankhauser, C., Peters, A. et al. Scenario-based simulation training for the WHO hand hygiene self-assessment framework. Antimicrob Resist Infect Control 8 , 58 (2019). https://doi.org/10.1186/s13756-019-0511-9

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Safety and Infection Control NCLEX Practice Quiz (75 Questions)

Welcome to your NCLEX practice quiz on Safety and Infection Control. According to the NCLEX-RN test plan , about 9 to 15% of questions will come from this subcategory that includes content about the “ nurse ‘s ability required to protect clients, families, and healthcare personnel from health and environmental hazards.” Good luck, and hope you will learn a lot from this quiz.

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11 thoughts on “Safety and Infection Control NCLEX Practice Quiz (75 Questions)”

In # 5 the correct answer should be letter B right?

Please review question #5 in Safety and Infection Control NCLEX Practice Exam (Set 2: 25 Questions) I chose the correct answer which was cool air dryer and it was marked wrong. But in the rationales it had it correct. Thank you

Corrected! Thank you for letting us know.

in the first set of questions #16 about doing CPR. your rational for the answer being what it is states “The nurse should use the heel of one hand at the center of the chest, then place the heel of the other hand on top of the first hand and lace fingers together and give 30 compressions that are about 1” to 1½” deep.”

this is actually incorrect. per the American Heart Association, depth of compression on children is about 2 inches. answer C is more correct than D. just think the answers should be worded better and rationale should be corrected in the depth.

Question 19 regarding the child in foster care. Foster Parents do not have permission to sign informed consent on invasive procedures and need Social Worker permission. Most often the hospital/clinic will request a signature from Social Worker. The child is in the CUSTODY of the state and the CARE of the foster parent.

Thank you very much. It is a great site, very helpful. Please kindly review the answers of the following: Safety and Infection Control NCLEX Practice Exam | Quiz #2: Question 25 The posted answers were not correspond to the Question #25. Thanks again.

Thanks Kumari, this has been fixed! :)

For Q#25 for Safety and Infection Control NCLEX Practice Exam Quiz #2, the rationale given does not match the question & its answer choices. Can you fix this, please?

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the test was completed how i can get the certificate or anything elses to be done

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Essentials of Nursing Adults

Student resources, chapter 14: infection prevention and control.

1. Which of the following is NOT a sign of systemic infection?

• aching and weakness
• redness and swelling
• nausea and vomiting

2. Good infection prevention and control practices aim to protect which of the following groups of people?

• patients and carers
• healthcare workers
• all of these

3. How many links of the chain of infection are required to occur together to cause infection?

4. The class of relationship where one organism benefits from another without affecting it is known as ______.

• pathogenesis
• commensalism

5. SICPs are intended for use ______ whether infection is known to be present or not.

• by some health and social care staff in all health and social care settings at all times
• by all health and social care staff in some health and social care settings at all times
• by all health and social care staff in all health and social care settings sometimes
• by all health and social care staff in all health and social care settings at all times

6. Which of the following is NOT part of standard infection control precaution practice?

• placing a patient in an isolation room
• washing hands with soap and water
• disposing of sharps in a sharps container
• managing a blood or body fluid spillage

7. What type of precautions are required when managing an infectious patient?

• standard infection control precautions
• transmission based precautions
• standard infection control precautions and transmission based precautions
• no precautions

8. Promoting good infection prevention and control practice ______.

• reduces compliance with contemporary infection control practices
• limits risk of infection
• causes media attention
• risks litigation

9. The micro-organism Staphylococcus aureus is a ______.

10. According to the World Health Organization’s 5 moments for hand hygiene, healthcare workers should wash their hands ______.

• before touching a patient
• before carrying out an aseptic procedure
• before exposure to body fluid risk
• after touching a patient or their surroundings

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4.2: Chain of Infection

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The chain of infection , also referred to as the chain of transmission, describes how an infection spreads based on these six links of transmission:

• Infectious Agent
• Portal of Exit
• Modes of Transmission
• Portal of Entry
• Susceptible Host

See Figure 4.1 [1] for an illustration of the chain of infection. If any “link” in the chain of infection is removed or neutralized, transmission of infection will not occur. Health care workers must understand how an infectious agent spreads via the chain of transmission so they can break the chain and prevent the transmission of infectious disease. Routine hygienic practices, standard precautions, and transmission-based precautions are used to break the chain of transmission.

The links in the chain of infection include Infectious Agent, Reservoir, Portal of Exit, Mode of Transmission, Portal of Entry, and Susceptible Host [2] :

• Infectious Agent : Microorganisms, such as bacteria, viruses, fungi, or parasites, that can cause infectious disease.
• Reservoir : The host in which infectious agents live, grow, and multiply. Humans, animals, and the environment can be reservoirs. Examples of reservoirs are a person with a common cold, a dog with rabies, or standing water with bacteria. Sometimes a person may carry an infectious agent but is not symptomatic or ill. This is referred to as being colonized , and the person is referred to as a carrier . For example, many health care workers carry methicillin-resistant Staphylococcus aureus (MRSA) bacteria in their noses but are not symptomatic.
• Portal of Exit : The route by which an infectious agent escapes or leaves the reservoir. In humans, the portal of exit is typically a mucous membrane or other opening in the skin. For example, pathogens that cause respiratory diseases usually escape through a person’s nose or mouth.
• Mode of Transmission : The way in which an infectious agent travels to other people and places because they cannot travel on their own. Modes of transmission include contact, droplet, or airborne transmission. For example, touching sheets with drainage from one person’s infected wound and then touching another person without washing one’s hands is an example of contact transmission of an infectious agent. Examples of droplet or airborne transmission are coughing and sneezing, depending on the size of the microorganism.
• Portal of Entry : The route by which an infectious agent enters a new host (i.e., the reverse of the portal of exit). For example, mucous membranes, skin breakdown, and artificial openings in the skin created for the insertion of medical equipment (such as intravenous lines) are at high risk for infection because they provide an open path for microorganisms to enter the body. Tubes inserted into mucous membranes, such as a urinary catheter, also facilitate the entrance of microorganisms into the body. A person’s immune system fights against infectious organisms that have entered the body through the use of nonspecific and specific defenses. Read more about defenses against microorganisms in the “ Defenses Against Transmission of Infection ” section of this chapter.
• Susceptible Host : A person at elevated risk for developing an infection when exposed to an infectious agent due to changes in their immune system defenses. For example, infants (up to 2 years old) and older adults (aged 65 or older) are at higher risk for developing infections due to underdeveloped or weakened immune systems. Additionally, anyone with chronic medical conditions (such as diabetes) are also at higher risk of developing an infection. In health care settings, almost every patient is considered a “susceptible host” because of preexisting illnesses, medical treatments, medical devices, or medications that increase their vulnerability to developing an infection when exposed to infectious agents in the health care environment. As caregivers, it is the NA’s responsibility to protect susceptible patients by breaking the chain of infection.

After a susceptible host becomes infected, they become a reservoir that can then transmit the infectious agent to another person. If an individual’s immune system successfully fights off the infectious agent, they may not develop an infection, but instead the person may become an asymptomatic “carrier” who can spread the infectious agent to another susceptible host. For example, individuals exposed to COVID-19 may not develop an active respiratory infection but can spread the virus to other susceptible hosts via sneezing.

Learn more about the chain of infection by expanding the element descriptors below.

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This H5P activity is a derivative of original activities by Michelle Hugues and licensed under CC BY-NC 4.0 unless otherwise noted.

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Putting It All Together

Note : To enlarge the print, you can expand the activity by clicking the arrows in the right upper corner of the text box. Please drag and drop the descriptors and actions into the appropriate boxes to demonstrate the various steps in the chain of infection.

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Healthcare-Acquired Infections

An infection that develops in an individual after being admitted to a health care facility or undergoing a medical procedure is a healthcare-associated infection (HAI) , formerly referred to as a nosocomial infection. About 1 in 31 hospital patients develops at least one healthcare-associated infection every day. HAIs increase the cost of care and delay recovery. They are associated with permanent disability, loss of wages, and even death. An example of an HAI is a skin infection that develops in a patient’s incision after they had surgery due to improper hand hygiene of health care workers. [3] , [4] It is important to understand the dangers of Healthcare-Acquired Infections and actions that can be taken to prevent them.

Read more details about healthcare-acquired infections in the “ Infection ” chapter of Open RN Nursing Fundamentals .

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Healthcare-Associated Infections by Michelle Hughes is licensed under CC BY 4.0.

• “Chain-of-Transmission” by unknown author is licensed under CC BY-NC 4.0 . Access for free at https://ecampusontario.pressbooks.pub/introductiontoipcp/chapter/40/ ↵
• Department of Health. (n.d.). Chain of infection in infection prevention and control (IPAC). The Government of Nunavut. https://www.gov.nu.ca/health/information/infection-prevention-and-control ↵
• This work is a derivative of Nursing Fundamentals by Chippewa Valley Technical College and is licensed under CC BY 4.0 ↵
• Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www.hhs.gov/oidp/topics/health-care-associated-infections/index.html ↵