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Folio edition · Set in Instrument Serif & Archivo

Paeds Vivasinfectious-diseases

Paeds Vivas · infectious-diseases

Infection prevention, isolation and outbreak management — branching viva

Branching structured-oral viva on paediatric infection prevention and control: the chain of infection and where each measure breaks a link; standard and transmission-based precautions matched to the route; the WHO 5 Moments of hand hygiene; device-related HAI bundles (CLABSI, VAP); and the stepwise outbreak response to a ward gastroenteritis cluster — recognition, case definition, early containment, epidemic-curve interpretation and standing down.

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Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the general paediatric registrar on a paediatric ward. Over 36 hours, three children and a nurse on one bay develop explosive vomiting and diarrhoea; two children have needed admission for rehydration. On the adjacent bay is a central-line-dependent oncology patient. The examiner asks you to take the candidate through the principles of infection prevention, the immediate management of this suspected outbreak, and how the same thinking applies to a device-related infection on the unit.

Opening question. Take me through the chain of infection and explain how each of your infection-control measures breaks a single link. [1]

Branch — standard precautions. What are standard precautions, and why do they apply to every patient regardless of diagnosis? Name the WHO 5 Moments of hand hygiene and tell me when alcohol-based rub is sufficient and when you must use soap and water. [1]

Branch — transmission-based precautions. Now match the precaution to the route: contact, droplet and airborne. Give me two example organisms for each and the PPE and room requirements. Why is norovirus not adequately controlled by alcohol-based hand rub alone? [4]

Branch — the outbreak in front of you. Three cases in 36 hours on one bay. Is this an outbreak, and what is your immediate response? Define a case for me. Do you wait for laboratory confirmation before acting? [4]

Branch — the epidemic curve. Sketch the epidemic curve for a point-source outbreak versus a propagating outbreak. How does the shape guide your investigation of the source and the mode of transmission? What is a pseudo-outbreak, and how do you tell it apart from a true outbreak? [4]

Branch — protecting the oncology patient. The central-line-dependent child on the next bay — what additional measures protect this patient, and how would you investigate and prevent a central-line bloodstream infection on the unit? Walk me through the CLABSI bundle. [5]

Branch — the system and the evidence. Where does this event fit in the HAI burden, and what surveillance and audit measures would you expect to find running in the background? Name the guidelines and the regional bodies that govern this practice in ANZ, the UK, the US and Canada. [6] [4]

Closing. Summarise, in one minute, the principles that make paediatric IPC a system rather than a list of rules — and tell me the single most important measure on your ward today. [1]

References

  1. [1]Allegranzi B; Pittet D Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect, 2009.PMID 19720430
  2. [4]Yokoe DS; Mermel LA; Anderson DJ; Arias KM; et al A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol, 2008.PMID 18840084
  3. [5]Polin RA; Denson S; Brady MT; Committee on Fetus and Newborn; Committee on Infectious Diseases Strategies for prevention of health care-associated infections in the NICU. Pediatrics, 2012.PMID 22451712
  4. [6]Magill SS; Edwards JR; Bamberg W; Beldavs ZG; et al Multistate point-prevalence survey of health care-associated infections. N Engl J Med, 2014.PMID 24670166