, Question 1
A hospital's SSI rate for colorectal surgery is elevated despite compliance with
SCIP measures. Which additional bundled intervention, supported by the
strongest current evidence, is most likely to reduce SSI in this population?
A. Preoperative oral antibiotic prophylaxis with mechanical bowel
preparation
B. Intraoperative wound irrigation with povidone-iodine
C. Postoperative supplemental oxygen at 80% FiO2 for 6 hours
D. Strict perioperative glycemic control (target <110 mg/dL)
Correct Answer: A - Preoperative oral antibiotic prophylaxis
with mechanical bowel preparation
RATIONALE
Recent randomized trials and guidelines (e.g., WHO, ACS/IDSA)
support combined oral antibiotics with mechanical bowel preparation
for elective colorectal surgery to reduce SSI. Povidone-iodine
irrigation (B) has limited evidence and may cause tissue toxicity.
Supplemental oxygen (C) and tight glycemic control (D) have
mixed/limited evidence for SSI reduction in this context.
Question 2
Following a sterilization cycle, a biological indicator (BI) incubated for 24
hours shows no color change, but the internal chemical indicator on the pack
shows a pass. The sterilizer's physical parameters (time, temperature, pressure)
were within range. What is the most appropriate next step?
A. Release the load because the BI and CI both passed.
B. Quarantine the load and repeat sterilization after confirming BI results.
C. Investigate potential BI failure due to improper incubation or control.
D. Reprocess the load only if the CI was from the same lot.
Correct Answer: B - Quarantine the load and repeat sterilization
after confirming BI results.
Page 2
, RATIONALE
A passing BI is required for release; if the BI fails (color change), the
load must be quarantined and reprocessed. Here, the BI shows no
color change (pass) and CI passes, so the load can be released-but the
question states 'no color change' meaning pass. Wait, re-read: 'no color
change' means pass for most BIs. So correct answer is A? Actually,
many BIs require color change to indicate pass. Let's clarify: For
steam BI, a color change from purple to yellow indicates pass. No
color change = fail. Thus, if BI shows no color change, it's a fail. So
quarantine and reprocess. Correct is B. Explanation: No color change
indicates BI failure. Load must be quarantined and reprocessed. CI
pass does not override BI failure. Physical parameters alone are
insufficient.
Question 3
Which of the following statements best describes the current CDC
recommendation regarding the use of antimicrobial-coated sutures for SSI
prevention?
A. They are recommended for all surgical procedures to reduce SSI.
B. They should be avoided due to increased risk of antimicrobial
resistance.
C. They may be considered for use in procedures with high SSI risk,
based on evidence.
D. They are only effective when combined with postoperative antibiotic
prophylaxis.
Correct Answer: C - They may be considered for use in
procedures with high SSI risk, based on evidence.
Page 3
, RATIONALE
CDC guidelines (2017) and WHO recommend considering
antimicrobial-coated sutures to reduce SSI, particularly in
clean-contaminated and contaminated procedures. They are not
universally recommended (A), not avoided (B), and do not require
postoperative antibiotics (D).
Question 4
A steam sterilizer at 132°C (270°F) for 4 minutes is used for a wrapped
instrument set. The set includes a lumened device with a 2 mm diameter and 1
m length. According to AAMI ST79, which factor is most critical to ensure
sterilization efficacy?
A. The use of a single-ply wrapper to allow steam penetration.
B. Placement of the lumened device with its lumen dependent to facilitate
air removal.
C. The use of a pre-vacuum cycle to ensure air removal from the lumen.
D. Increasing the sterilization time to 10 minutes to compensate for the
lumen.
Correct Answer: C - The use of a pre-vacuum cycle to ensure air
removal from the lumen.
RATIONALE
For lumened devices, air removal is critical; a pre-vacuum sterilizer is
required for effective steam penetration into narrow lumens. Gravity
displacement cycles are insufficient. Wrapper type (A) and positioning
(B) are important but secondary. Increasing time (D) alone does not
remove trapped air.
Question 5
Which of the following best explains why high-level disinfection (HLD) is
insufficient for prion-contaminated instruments, and what is the recommended
sterilization method?
Page 4
A hospital's SSI rate for colorectal surgery is elevated despite compliance with
SCIP measures. Which additional bundled intervention, supported by the
strongest current evidence, is most likely to reduce SSI in this population?
A. Preoperative oral antibiotic prophylaxis with mechanical bowel
preparation
B. Intraoperative wound irrigation with povidone-iodine
C. Postoperative supplemental oxygen at 80% FiO2 for 6 hours
D. Strict perioperative glycemic control (target <110 mg/dL)
Correct Answer: A - Preoperative oral antibiotic prophylaxis
with mechanical bowel preparation
RATIONALE
Recent randomized trials and guidelines (e.g., WHO, ACS/IDSA)
support combined oral antibiotics with mechanical bowel preparation
for elective colorectal surgery to reduce SSI. Povidone-iodine
irrigation (B) has limited evidence and may cause tissue toxicity.
Supplemental oxygen (C) and tight glycemic control (D) have
mixed/limited evidence for SSI reduction in this context.
Question 2
Following a sterilization cycle, a biological indicator (BI) incubated for 24
hours shows no color change, but the internal chemical indicator on the pack
shows a pass. The sterilizer's physical parameters (time, temperature, pressure)
were within range. What is the most appropriate next step?
A. Release the load because the BI and CI both passed.
B. Quarantine the load and repeat sterilization after confirming BI results.
C. Investigate potential BI failure due to improper incubation or control.
D. Reprocess the load only if the CI was from the same lot.
Correct Answer: B - Quarantine the load and repeat sterilization
after confirming BI results.
Page 2
, RATIONALE
A passing BI is required for release; if the BI fails (color change), the
load must be quarantined and reprocessed. Here, the BI shows no
color change (pass) and CI passes, so the load can be released-but the
question states 'no color change' meaning pass. Wait, re-read: 'no color
change' means pass for most BIs. So correct answer is A? Actually,
many BIs require color change to indicate pass. Let's clarify: For
steam BI, a color change from purple to yellow indicates pass. No
color change = fail. Thus, if BI shows no color change, it's a fail. So
quarantine and reprocess. Correct is B. Explanation: No color change
indicates BI failure. Load must be quarantined and reprocessed. CI
pass does not override BI failure. Physical parameters alone are
insufficient.
Question 3
Which of the following statements best describes the current CDC
recommendation regarding the use of antimicrobial-coated sutures for SSI
prevention?
A. They are recommended for all surgical procedures to reduce SSI.
B. They should be avoided due to increased risk of antimicrobial
resistance.
C. They may be considered for use in procedures with high SSI risk,
based on evidence.
D. They are only effective when combined with postoperative antibiotic
prophylaxis.
Correct Answer: C - They may be considered for use in
procedures with high SSI risk, based on evidence.
Page 3
, RATIONALE
CDC guidelines (2017) and WHO recommend considering
antimicrobial-coated sutures to reduce SSI, particularly in
clean-contaminated and contaminated procedures. They are not
universally recommended (A), not avoided (B), and do not require
postoperative antibiotics (D).
Question 4
A steam sterilizer at 132°C (270°F) for 4 minutes is used for a wrapped
instrument set. The set includes a lumened device with a 2 mm diameter and 1
m length. According to AAMI ST79, which factor is most critical to ensure
sterilization efficacy?
A. The use of a single-ply wrapper to allow steam penetration.
B. Placement of the lumened device with its lumen dependent to facilitate
air removal.
C. The use of a pre-vacuum cycle to ensure air removal from the lumen.
D. Increasing the sterilization time to 10 minutes to compensate for the
lumen.
Correct Answer: C - The use of a pre-vacuum cycle to ensure air
removal from the lumen.
RATIONALE
For lumened devices, air removal is critical; a pre-vacuum sterilizer is
required for effective steam penetration into narrow lumens. Gravity
displacement cycles are insufficient. Wrapper type (A) and positioning
(B) are important but secondary. Increasing time (D) alone does not
remove trapped air.
Question 5
Which of the following best explains why high-level disinfection (HLD) is
insufficient for prion-contaminated instruments, and what is the recommended
sterilization method?
Page 4
