CBAHI Staff interview questions for Operating room staff uestions Answers Applicable How youdeal with | Infected cases are scheduled towards the end of the | All staff Patients with operating list, if its airborne transmission we Intubate transmissible and extubate in negative pressure room. For contact diseases? and droplet transmission-based precaution in the recovery room. Terminal cleaning after procedure. How frequent do you | Cleaned by technician with hospicide spray - After each | Anesthesia clean / disinfect case — End of the working hours / shift - Checklist to be tech anesthesia machines? | completed — shown. How frequent do you | Beginning of the day — in between cases ~ End of the | All staff clean / disinfect day —as per cleaning schedule — housekeeping staff. operating rooms? All staff Is operating room is positive / negative pressure Positive pressure with respect to corridors - >15 Air cycles per hour - Air is introduced near the ceiling and exhausted near the floor - through High-Efficiency Particulate Air (HEPA) filters that are maintained and changed every 6 months - Negative pressure room ‘One negative pressure room near recovery room. All staff Temp, humidity, & Differential pressure. Temperature 21 °C to 24 °C — Humidity - 20% to 60% Differential pressure -#2to+8 All staff What do you know about chemical indicators and Biological indicators? Chemical indicators are used in every package. Biological indicators are used at least weekly. All staff Do you re - process single use devices. No re use of Sneee pats ipto be re-used — justification by HOD Sappfoval from infection control. All staff | place it in closed container with biohazard logo and | All staff What you do after instruments used or | spray it with Instru — clean after that | send it for CSSD. became contaminated? Traffic control Should be able to identify restricted — semi restricted & | All staff non -restricted. Scanned with CamScannerCBAHI Staff interview Questions & Answers [Questions ‘Answers ‘Applicable | What are standard precautions Precautions applied for th irrespective of their diagnosis and presumed i status. infection e care of all patients Medical staff Contents/ components of standard precautions [@)Hand hygiene — hand wash — when visibly soiled *40-60- sec— hand rub when visibly clean ~ 20 -30 sec ~@ Appropriate use of PPE -G Sharp disposal Q) Cough etiquette -®) Environmental cleaning@) Safe injection practices. Medical staff Do you know about five moments for HH? Before touching a patient - before clean/aseptic procedures - after body fluid exposure risk - after touching a patient - and after touching patient's surroundings. Medical staff Personal protective equipment ‘All size PPE available — Donning sequence ~ Gown — mask — goggles — face shield - Gloves. Doffing sequence — Gloves — Face shield — goggles - Mask. N-95 masks — Fit tested mask— remember your size ~ fit check each time before wearing ~ Single use — If not available ~5 time per shift. Medical staff Training for PPE conducted. Competency and lecture. Medical staff Do you have spill kit? Yes, | have (Should be able to locate) Medical staff Do you know how to use it? Yes, | know there is steps write on it and | follow it. Identify the spill - Locate Spill kit - wear PPE — Place sign board — Place towels - Prep & spray Clorox 1:10 -— wait 15 to 20mins - Wipe — discard PPE Inform Housekeeping to clean the place. Medical staff What is transmission based — precautions and the color coding. Precautions based on the mode of transmission of disease — 3 transmission based — precautions — Airborne -Blue - negative pressure room — N95 — Fit tested — remember the size — close door always Droplet- GR) Single room ~ surgical mask. Contact - ff - single room-PPE. Medical staff How do you transfer patient with transmission-based precautions inside / outside the hospital? Inside the hospital - radiology — inform receiving department - Place TBP card — wear PPE —put mask for patient if on droplet/ airborne — transport during low / no traffic. Medical staff Outside the hospital - Inform the condition through Scanned with CamScannerCBAHI Staff interview Questions & Answers precautions Questions ‘Answers, ‘Applicable What are standard| Precautions applied for the care of all patients Medical staff irrespective of their diagnosis and presumed infection status. Contents/ components of standard precautions 11. Hand hygiene — hand wash - when visibly soiled- 40-60- sec hand rub when visibly clean ~ 20 -30 sec ~2. Appropriate use of PPE ~ 3. Sharp disposal ~ 4. Cough etiquette - 5. Environmental cleaning.6. Safe injection practices. Medical staff Do you know about five moments for HH? surroundings. Personal protective equipment Training for PPE conducted. Before touching a patient - before clean/aseptic Medical staff procedures - after body fluid exposure risk - after touching a patient - and after touching patient's ‘Allsize PPE available — Donning sequence-Gown— | Medical staff mask — goggles — face shield - Gloves. Doffing sequence — Gloves ~ Face shield — goggles ~ Mask. N-95 masks — Fit tested mask - remember your size - fit check each time before wearing — Single use — IF not available —5 time per shift. ‘Competency and lecture. Medical staff Yes, | have (Should be able to locate) Medical staff Medical staff Do you have spill kit? Do you know how to use it? Yes, | know there is steps write on it and | follow it. Identify the spill - Locate Spill kit - wear PPE — Place sign board - Place towels — Prep & spray Clorox 1:10 — wait 15 to 20mins - Wipe — discard PPE -Inform Housekeeping to clean the place. Medical staff What is transmission based - precautions and the color coding. Precautions based on the mode of transmission of disease —3 transmission based ~ precautions ~ Airborne -BJld - negative pressure room — N95 - Fit tested — remember the size - close door always Droplet-[{@f)- Single room — surgical mask. Contact - (fa - single room ~ PPE. ohend Mer edit esp How do you transfer patient with transmission-based precautions inside / outside the hospital? Inside the hospital - radiology ~ inform receiving department - Place TBP card — wear PPE -put mask for patient if on droplet/ airborne transport during low / no traffic. Medical staff Outside the hospital - Inform the condition through Scanned with CamScannermedical report — isolation needed — results — once ptedsyansport - clean the ambulance. /-sorne isolation room Vip cc = (More than -2) Pascal differential | Medical staff pressure ~ Monitoring daily if patient present - Weekly monitoring if no patient — Change of HEPA filter every 6 months — Label present on HEPA filter — If alarm - inform maintenance — infection control. Transfer in & Transfer | As per policy all transfer in patients from other Medical staff out of patients. hospital will be on contact precautions until proven negative. - Transfer out - Will be screened for MRSA / VRE / epidemiological organisms. Do have sufficient Yes, we have Regular supply of PPE, disinfectant & HH | Medical staff equipment and supplies | supplies. for the support of the infection prevention and control program? [Do you know where Yes, it’s here in the computer. (Document gate) Medical staff | your infection (4 pe) prevel and control manual? Medical staff Did you receive an IPC orientation upon hiring? Yes, we had general orientation for 4 days & IPC for four hours. Do you know about outbreak investigation? itis an increase in the number of Hospital Acquired Infection above the known basal level known to the facility. Medical staff Medical staff rates? Type of surveillance conducted displayed in department. Targeted surveillance What do you do after Wash hands in running water — do not squeeze - First needle stick exposure? | aid dressing — inform charge nurse ~ supervisor — inform EHC/IPC- visit EHC. 2-payee heath cline Holiday / off duty - visit ER. Did you receive the MMR, Varicella & Hep-b Medical staff vaccination upon hiring? | Yes, | have protected titer {it must be more than 10). Do you know about Hep B serological titer? sorte |Aqscad fe chn- [Do you know your HAI | Yes, we have monthly HAl rates communicated and | ICU Staff Do you know bundle for prevention of epidemiologically significant healthcare | associated infections? bundle, CLABSI bundle, SSI bundle & MDRO bundle. chen hid Yes, | know. There are 5 bundles VAP bundle, CAUTI Medical staff CAUTL x (wheter —Assccncted «uri HpR0 rit. diay PRsistast Ronin SST 7 MYC site Yen Clppsins otrd- Lx asetidd —al strtan. tf Scanned with CamScannerinstruments used or became contaminated? spray it with Instru ~ ¢ ssp. Assess for the been ima ae done-The UChas [AIT nurses. & caeeiUctieatasted hee daily meatal hygiene - | doctors. container perfor ey fe procedure into a clean soves worn b med and disposable apron and yefore and after procedure. Remove har if necessary by clipping-Administer | All_ nurses & Do oe prophylaxis within one hour before operation: doctors. bundle? “fe~* 5" patient's body temperature was normal- patient’s ctor blood glucose level was normal- Disinfect skin _— preoperatively b chlorhexidine. Aseptic technique ‘Access with Single use sterile devices ~ clean the ‘All nurses & rubber septum with alcohol ~single dose vials-no | doctors. left over to be preserved. ‘What construction, | Any renovation, construction nthe hospitaltobe | CharBe nurses renovation & ICRA approved by IPC, Safety & admin with permission |/ Head of the (infection control risk form filled according to ICRA. department. assessment) Schedules / disinfectant | Housekeeping leaning schedule — List of agents is Housekeeping for housekeeping are approved by IPC committee. / Charge reviewed by IPC. nurses. Cleaning/ disinfection | Housekeeping Schedule includes all environmental Housekeeping schedule surfaces — Nurses station / equipment schedule- | / Charge includes equipment. nurses. ‘Sharp boxes Sharp to be discarded immediately to Sharp boxes- | Medical staff No recapping —if recapping is necessary follow scoop |/ method. Sharp box ~ secure before using -tobe Housekeeping iscarded when — its % full bad odor arises — week. | staff. How do you notify ‘Complete notification form as per disease and send to All nurses & Communicable diseases | Infection control If off duty call~ Infection control doctors. | practitioner. Do you re- process No re use of single use items — if to be re-used — Medical staff single use devices. justification by HOD approval from infection control. What you know about | We have pest control policy - schedule ~ 2 times / All staff pest control / what you | week- ‘Thursday & Friday — if any pest found — inform will do if you found pest. infection control. What you do after place it in closed container with biohazard logo and | Nursing staff Jean after that | send it for cohol & 0.108 Chlorhexidine) Hospicide spray (70% al Nursing staff Disinfectant to clean Scanned with Cai imScannerStandard Precautions Definition: Standard precautions are away to by contact with blood, body ful prevent transmission of infection that can be acquired nor-intactskin mucus.membrane etc.. It should be used in the care of all patients all of the time. Hand Hygiene: When: Pay Before touching the patient After touching a patient | Before clean aseptic procedure P- Rte body fluid exposure: such as drawing or handling blood; cleaning uP urine or feces; handling waste After touching patient surrounding: speed adjustment s: Examples: Changing bed linens, perfusion ‘Also immediately after removing gloves or other protective clothing, after coughing How: = When Hands are visibly soiled( hand washing for 30-60 sec): Perform hand washing with soap and water ae 30 sec): ly soiled(Hand rubbing for 20-3 - When Hands are not visil I-based preparation Perform hand rubbing with an alcohol Personal protective equipment (PPE): PPE includes: Gloves, Gown, Face mask, eye protection (goggles and face shields) > Gloves should be single use and discard before touching non- > Remove gloves promptly after use contaminated items or environment to another patient > Wash hands immediately after removin > Wear a fluid resistant, non-sterile gown procedures or activities where contact wit anticipated > Do not wear the same gown for the care of al surfaces, and before providing care g gloves to protect skin and clothing during h blood or body fluids is more than one patient Scanned with CamScannervvvy vv vvvvv vvv Wear a face mask when there is potential contact with respiratory secretions and sprays of blood or body fluids, Wear eye protection (goggles and face shields) for potential splash or spray of blood, respiratory secretions, or other body fluids Removal of PPE: ppe should be removed in the following order: Gloves—Gown—Eye Goggles—Mask—Decontaminate hands. Respiratory hygiene and cough etiquette: Education of health workers, patients and visitors. Covering mouth and nose when coughing or sneezing. Hand hygiene after contact with respiratory secretions. Isolation of patients with acute febrile respiratory symptoms. Persons with respiratory symptoms should apply source control measures: Cover their nose and mouth when coughing/sneezing with tissue or mask, dispose of used tissues and masks, and perform hand hygiene after contact with respiratory secretions. Needle sticks and sharps Injury Prevention: Used needles should be discarded immediately after use and not recapped, bent, cut, removed from the syringe. Any used needles or other sharps should be placed in a sharp container. Don't overfill sharp containers. Discard after 2/3 full. Safe Injection Practices: All injections should be prepared in a clean area. ‘An aseptic technique must be used when drawing up injections Needles, syringes , Intravenous fluids and cannulae are sterile, single use items; they must not be reused for another patient Use single dose vials wherever possible Do not use single dose vials for multiple patients Label multiple dose vial with patients name and date opened Do not leave multiple dose vials at a patient's bedside Do not use bags or bottles of intravenous fluids for multiple patients Environmental Cleanin: Routine environmental cleaning is required to minimize the number of micro-organisms in the environment, Ensure all environmental surfaces, particularly those in contact with patients (bedrails, mattress, bedside tables, commodes, doorknobs, Scanned with CamScannersinks...) ate routinely cleaned with regi jisinfectant following the ith the one ith registered disinfectant following t! Medical Devices/Patient Care Equipment: > Medical devices labeled as “Single Use ‘Only’ are not reprocessed or reused. > "Reusable Equipment’ should be appropriately decontaminated between patients Spillages: it should be dealt with immediately > Spillages of blood, urine, faces or vom! wearing PPE and must be decontaminated immediately by staff trained to undertake this safely. > Spill Kits are available in ea located. For spillages of body fluid (e. > Soak up as much of the visible mat paper towels. }> dispose of the soiled paper towels >> clean the area using warm water and di > discard gloves and apron > decontaminate hands For blood spillages: > decontaminate all blood spills with a proper disinfectant > wipe up the spillage with ‘disposable paper towels and discard intoa yellow healthcare risk bag > ‘Wash the area with a general purpose neutral detergent and water. F Giscard gloves and apron into healthcare risk bag > decontaminate hands ch area and all staff should know where it g. urine, faces or vomit): serial as possible with disposable isinfectant Scanned with CamScannerTransmissj | Mission-Baseq Precautions jsmission-based Precautions are Contact, Airb, , Airborne ar ission-based precauti ind Droplet Precautions sransiissi cautions (TBPs) standard precautions are used in ad et alone may be ieuicent to" pear erautons mission of contact Precautions: Red color > Transmission from persor I m person to pers ” alison Cont peta oni. patient room is a i 7 > Wash hands and wear Prered for patients who require Contact Precautions ioe eniting the patient eae fuctng the patient and propery discarding imit tran esses inne movemont of patients outside of the room to medically- inetd eee neces. When transport or movement is necessary, cover the perp ened dn Patient's body, Remove of contaminated PPE and perform PPE to handle the p cee patients on Contact Precautions. Don clean fe transport location. > es disposable or dedicated patient-care equipment (e.., blood pressure cults). Mf common use of equipment for multiple patients is unavoidable, clean and lisinfect such equipment before use on another patient > Clean and disinfect the room regularly. Droplet Precautions: Green color > Transmission via respiratory secretions ffom one person to another ©.9- influenza, pertussis (whooping cough), rubella. Asingle-patient room is preferred Source control: put a mask on the patient Donmask upon entry into the patient room Limit transport and movement of patients outside of the room Hand hygiene vvvvy Airborne Precautions: Blue color > Transmission via the air from one person to another @.g., pulmonary tuberculosis, chickenpox, measles Ensure appropriate patient placement in an airborne infection isolation > Foom (AlIR): - negative air pressure room (~ 2 to ~ 8) with the HEPA fter.6-12 tir changes per hour, keep the patient inside the room and keep the room door closed. > Source control: put a mask on the patient > Use personal protective equipment (PPE) appropriately, including a NOS Mask > Limit transport and movement of patients outside of the room > Hand hygiene Scanned with CamScannerLASA : define LASA: a spelling similarities or similar phonetics. 1edications similar visually in physical appearance and packaging, or medications with Q: LASA errors preventive strategy: ((staff interview and observation) Physician role Pharmacist role Nurse role * Townite clear, ‘© Use warning labels (orange = Read label carefully and revise purpose complete order color) ‘Always make independent double check ‘© Clear communication ‘© Use special containers (yellow (dispense, supply & administration) boxes) © Check dose appropriately before Use generic and brand names Separate items on shelves Clear prescription with (arrange in non-alphabetical diagnosis order) + Avoid verbal and Qistorage of LASA telephone order. © Implementation of approved and prohibited list of abbreviations. administration ‘© Report to pharmacy if any confusion ‘Always perform the triangle check (a) ‘© Triangle check isto revise 1. Actual ampoule label with 2. Prescription form, to be matching with the 3. Medication administration record sheet (MAR) \: prescription of LASA Scanned with CamScannerHAM Qdefine HAM: ‘A: Medications that have high risk to cause significant patient harm if used in error. (Q: HAM errors preventive strategy: (staff interview and observation)) Physician role + Towrite clear, complete order Clear communication Use generic and brand names + Clear prescription with diagnosis + Avoid verbal and telephone order. + Implementation of approved and prohibited lst of abbreviations. Q5 prescription of HAM Pharmacist role Use warning labels (red color) * Use special containers (red boxes) ‘© Use closed cabinet (limited access). Limited amount + Independent double check before dispensing * Annually update the list of HAM. Qi storage of HAM ‘Nurse role ‘Read label carefully and revise purpose ‘© Always make independent double check (dispense, supply & administration) ‘+ Check dose appropriately before administration ‘© Report to pharmacy ifany confusion ‘* Always perform the triangle check (Q) ‘© Triangle check isto revise 1, Actual ampoule label with 2. Prescription form, to be matching with the 3. Medication ‘administration record sheet (MAR) , ‘© Close monitor of the patient especially for the first dose, in OR patient is highly ‘monitored all the time Qiwhat’s meant by independent double check? Can you make @ demo.? ‘© independently compare the label and the product contents in hand versus the written order ‘© Independently verify any calculations for doses that require preparation (medications not dispensed at patient unit) © Ensure accuracy of infusion pump programming for continuous intravenous infusion of medications, eg: TIVA Scanned with CamScannerQs precautions before any infusion: ‘+ Revise the 10 rights of medication administration ‘+The intended infusion is going to the intended canal ‘© The infusion pump is programmed at the proper rate Q¢ patient is endorsed to OR from ICU, with infusion pumps and ongoing medications, what you should check before accepting the patient? Asthe receiving nurse should check for right patient, right medication, right rate of infusion, and right concentration of medication versus the written order. Q: Did you receive education on LASA & HAM? A:YES Q: D0 you know how you can access the standard concentration of IV infusions? ‘Ardocument gate, CPG “clinical practice guidelines”, pharmacy, standard concentration of IV infusions. Q: how can you access LASA & HAM policies? ‘As regulatory documents, departmental manuals, pharmacy, policies. High alert medication plan: hospital wide manual, pharmacy Q4:do you know how to access medication error form & ADR (adverse drug reaction form) A: patient file form. Q: what's meant by blanket orders? ‘Asorderby the patient to continue the same previous medication orders, without detailed revision of each item, and it’s prohibited N.B: ‘* Antibiotic prophylaxis ordered by the surgeon preoperatively, and sent with the patient tobe given by the anesthetist in majority of cases, the indicator data is collected by the anesthetist to be sent for quality department. © The antibiotic choice should be guided by the guidelines for antibiotics (on document gate) and the choice is the responsiblity of the MRP and the clinical pharmacist observation. Scanned with CamScanner‘+ Drug dosages are calculated as per the patient BMI as the weight and height are always recorded in the anesthetist intraoperative sheet, and he is the one responsible to determine the appropriate drug dosages as per age, weight and operative conditions. ‘+ Abbreviation are generally prohibited, but there isa list for approved and prohibited abbreviations, show me how you can access on your regulatory documents? Q Q: BY OBSERVATION/ staff interview: ‘© Temperature, light, humidity and sanitation are maintained in medication floor stock + Separate FEFO (frst expire, first out. ‘+ Expired & damaged drugs are separated and labelled ‘Antiseptic solutions are separated from medications ‘+ Wellfunctioning thermometers for refrigerator (2-8.0C) and free available er (-10--200C) are © No food, drugs, samples or culture tubes are to be in refrigerator. ‘© Hazardous medications are not available in OR. Verbal / telephone order Verbal order Telephone order © Foremergencies + Physician should sign once emergency ends ‘+ Receiver should repeat back ‘+ MRP is physically present and gives ‘order to nurse, eg: during CPR, ER emergencies and while performing procedures and physician hands are not free For urgencies Physician should sign within 30 minutes Receiver should read back with the speaker on and a witness nurse is available Urgency means that the patient need to receive the medication within 30 minute, it also includes AMA. attached to crash cart. “There are special forms for both orders but not applicable in OR, except CPR form, Scanned with CamScanner/ qs crash cart attached forms: a Crash cart checking rotational schedule, ‘© Crash cart checklist for Equipments, disposables and medications ‘¢ Defibrillator testing log book Crash cart medication list ‘© Crash cart deficiency form + Crash cart drug calculation chart. © CPRform. ‘Q:how and when you are going to refill crash cart after usage? where is the stock of plastic locks? ino is responsible to replace the lock? “observation “ «© Availability and accessibility of spill kits and PPE ‘© MSDS (observation and staff interview) ‘a: what's the action taken incase of chemical spl (formaldehyde spillage?) ‘az what's meant by MSDS? Staff awareness about resnant ‘and breast feeding precautions??? ‘a: how-an you access MSDS? {in OR we should have eye wash station and emergency water shower??22?2772)) Q: by observation: ‘Operating rooms medication ists Floor stock medication lst Floor stock separated and labelled medications Limited , appropriate and approved floor stock medications vial heparin vial, and farcoline for nebulization) 272 creams??? They: should hav date of opening, expiry date and initials ofthe staff opened It MV (mult-dose vials and containers re.glidacane, bupivacaine, neostigmine labetalol ethe Scanned with CamScanner‘a: who is responsible to collect patient own medications? ‘A: the inpatient ward nurse where those medications are to be kept? A internal pharmacy Narcotics Q: who is responsible for control of narcotics ? (staff interview) A REFER TO POLICY OF HANDLING OF NARCOTICS ‘STAFF INTERVIEW ‘OBSERVATION DOCUMENT REVIEW Narcotic physical count and Narcotic cabinet is steel, ~ Prescriptions and accountability double check and double endorsement records Qiwho is responsible for control of door . narcotic? + Empty containers + Narcotic limited supply ‘© Count and review ‘+ Disposal of un-used part ‘¢ Narcotic documents ‘© Narcotic antidote drugs © Empty containers «© Disposal of unused {flumazenil and naloxone ) remnants are available show me how you will document narcotic count and ‘empty containers? ‘Qthow you can identify the privilege ofthe prescriber? Asthrough ourregulatory documents, privilege, prescriber. privilege to revise the drug and the. specialty of the prescriber a Scanned with CamScanner