Question

Critical Thinking Questions 1. You are taking the general history of a 13-year-old female patient. You discover that she never had a second measles-mumps-rubella (MMR) vaccination. What special considerations, if any, should be taken into account before administering the vaccination? 2. While unloading the autoclave you discover that some of the sterilization indicators in the center of the load are not activated (no color change has occurred). What actions should you take? 3. You notice that a coworker is not washing her hands between patients or before eating lunch. What steps should you take? How would you explain the importance of hand washing to your coworker?

Answer 1

ANS 1 - ACIP and CDC recommend two doses of MMR vaccine routinely for children, starting with the first dose at age 12 through 15 months and the second dose at age 4 through 6 years before school entry. Children can receive the second dose earlier as long as it is at least 28 days after the first dose. To ensure protection, 2 doses of MMR with at least 4 weeks between doses is recommended as not everyone responds to the first dose. The second dose of MMR vaccine gives chilldren another opportunity to make a good response to the vaccine.

Hence she have not taken the second dose, it can be given now. The following conditions need to be kept in mind before administering the vaccination-

• Had a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Whether she suffered from any known severe immunodeficiency condition after the first dose
• Has a history of anaphylactic reactions to neomycin
• Have a Moderate or severe acute illness with or without fever

ANS 2 - If the load doesn't change color, it indicates that there is a problem in the sterilization process. If maybe that the minimum temperature is not reached or the autoclave may not be working properly. The actions to be taken are:

• The instruments that was initially put for sterilization need to be sterilized again properly
• The autoclave need to be checked for any defect, if exist it need to be fixed as soon as possible

ANS 3 - The coworker need to be sensitized on the importance of hand washing, she is not only making the patients prone to infection from other patient but also putting herself at risk of getting a infection such as :

• Preventing spread of infection from one patient to another
• Protecting self from getting an infection from patient
• Preventing spread of infection from self to the patient
• Also hand washing prevents spread of infection from that one health service provider to another.

Along with the importance she should be also explained about how hand washing should be done following all the steps as it covers the commonly missed steps. She should be also explained that medical hand washing should be done for 40 - 60 seconds.

Along with all these she should be explained that before and after every procedure, after touching each patient hand washing should be done. Also before and after eating food, after toilet hand washing is very important to prevent spread of disease.