CIC Study Guide Practice Test 1

CIC Study Guide Practice Test 1 1. The bacterium most likely to be transmitted from mother to infant during labor and cause neonatal sepsis is: a. Escherichia coli b. Staphylococcus aureus c. Group B Streptococcus d. Group A Streptococcus - 1. C Group B Streptococcus Rationale: In Group B Streptococcus (GBS) neonatal infections, heavy maternal colonization is associated with an increased risk for preterm labor, which in turn is a significant risk actor for neonatal infection. Intrauterine infection of the fetus therefore likely occurs via ascending spread of GBS from the vagina of a pregnant, asymptomatically colonized woman and subsequent rupture of membranes before 37 weeks' gestation. 2. Which of the following is an example of the criterion of "Strength of the Association" from Hill's criteria for causation? a. In a study of the association between antibiotic exposure and development of C. difficil infection, the odds ratio was 2:3 b. In a study of the association between antibiotic exposure and development of C. difficil infection, the authors' conclusions are consistent with those of three other studies c. In a study of the association between antibiotic exposure and development of C. difficil infection, antibiotic therapy began an average of 3 weeks before C. difficil infection developed d. In a study of the association between antibiotic exposure and development of C. difficil infection, prolonged antibiotic therapy was a greater risk factor for C. difficil infection than short-term antibiotic therapy - 2. A In a study of the association between antibiotic exposure and development of C. difficil infection, the odds ratio was 2:3 Rationale: Causal associations exist when evidence indicates that one factor is clearly shown to increase the probability of the occurrence of a disease. In a causal relationship, the reduction or diminution of a factor decreases the frequency of the disease being studied. The criteria currently used for causality were developed by Austin Bradford Hill and are known as Hill's criteria. These criteria use modern epidemiological methods to determine whether a factor is causal for a given disease. Strength of association is the firt criterion: The incidence of disease should be higher in those who are exposed to the factor under consideration than in those who are not exposed; that is, the stronger the association between an exposure and a disease, the more likely the exposure is to be causal. The odds ratio is a statistical measure that gives us an indication of how strongly the risk factor is associated with the disease outcome. 3. Which of the following rules should be followed when collecting a stool sample for C. difficil testing? 1) Stool sample should be freshly passed within 1-2 hours 2) 10-20mL. of formed stool should be collected 3) Stool should be passed into a clean, dry container 4) Specimens should be obtained before antimicrobial agents have been administered a. 1, 2 b. 2, 3 c. 1, 3 d. 1, 4 - 3. C 1, 3 Rationale: The accuracy of all tests depends on proper specimen handling and transport. The following rules should be followed when collecting samples for C. difficil testing:• Stool samples should be freshly passed within 1-2 hours• 10-20 mL of watery, soft, or unformed stool should be collected• Stool should be passed into a clean, dry container 4. What type of meningitis would be most consistent with the following cerebrospinal fluid CSF) report result: Glucose Decreased Protein Elevated WBC counts1,000/mm3 a. Bacterial b. Viral c. Fungal d. Tuberculosis - 4. A Bacterial Rationale: Culture of blood and CSF are indicated for patients with suspected invasive meningococcal disease. The CSF of patients with untreated meningococcal meningitis is usually cloudy and has pleocytosis with a predominance of neutrophils, low glucose, and high protein levels. In most of the cases, the organisms are seen on Gram stain or can be identified usinglatex agglutination assays. The culture is almost invariably positive as long as the sample was obtained before the administration of antibiotics. 5. The following blood culture result should be considered a potential contaminant: a. A positive result of coagulase-negative staphylococci from two sets, 2 days apart, without symptoms b. A positive result of S. aureus from one bottle in a patient with a temperature of 38.6°C c. A positive result of E. coli from one bottle in an afebrile patient with diarrhea d. A positive result of Candida albicans in a fungal blood culture in a patient with a urinary tract infection - 5. A A positive result of coagulase-negative staphylococci from two sets, 2 days apart, without symptoms Rationale: According to the CDC CLABSI criteria, common commensals (such as coagulase-negative staphylococci) meet the criteria for a CLABSI if there are two positive cultures from two or more sets of blood cultures drawn less than 2 days apart and the patient has symptoms (fever greater than 38°C, chills, or hypotension). CDC CLABSI criteria: Patient has at least one of the following signs or symptoms: fever (greater than 38°C), chills, or hypotension and positive laboratory results are not related to an infection at another site. And the same common commensal (i.e., diphtheroids [Corynebacterium spp. not C. diphtheriae], Bacillus spp. [not B. anthracis], Propionibacterium spp., coagulase-negative staphylococci [including S. epidermidis], viridans group streptococci, Aerococcus spp., and Micrococcus spp.) is cultured from two or more blood cultures drawn on separate occasions.Criterion elements must occur within a time frame that does not exceed a gap of 1 calendar day between two adjacent elements. 6. Which of the following organisms have been associated with the transmission of infections after body piercing? 1) Atypical Mycobacterium species 2) Staphylococcus species 3) Pseudomonas species 4) Haemophilus species a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4 - 6. A 1, 2, 3 Rationale: Body piercing activities can transmit infectious diseases. Bacterial infections may result from improper initial piercing technique or from poor hygiene. The organisms involved in most earlobe-piercing infections are often considered normal skin floa, including Staphylococcus and Streptococcus species. Higher ear piercings in the ear cartilage have been associated with more pathogenic organisms, including Pseudomonas species. Multiple cases of atypical Mycobacterium infections after piercing have been reported. 7. The Director of the Operating Room (OR) requests that the OR surfaces be routinely environmentally cultured. The IP's best response should be: a. A schedule for routine culturing of the OR should be arranged so that each room is cultured at a set interval b. Routine culturing of the OR should be done in the absence of any epidemiologic investigations in that area c. Routine culturing should not be done because it is too expensive d. Routine environmental culturing should not be considered unless an epidemiologic investigation is being conducted - 7. D Routine environmental culturing should not be considered unless an epidemiologic investigation is being conducted Rationale: Microbiological environmental testing is not generally recommended. Environmental culturing can be costly and may require special laboratory procedures. Additionally, in most cases no standards for comparison exist. Because of the lack of standards, environmental testing may generate inconclusive data that could result in the implementation of unnecessary procedures or treatment. Rationale for special environmental monitoring should be carefully planned and limited to epidemiological investigations. In limited situations, "routine" environmental sampling may be indicated. 8. All of the following may be indications of a heating, ventilation, and air conditioning (HVAC) malfunction except: a. An increase in the postoperative surgical site infection (SSI) rates b. A single case of aspergillosis in a severely immunosuppressed patient c. Healthcare-associated varicella infections d. An outbreak of ventilator-associated Acinetobacter infections in the Intensive Care Unit (ICU) - 8. D An outbreak of ventilator-associated Acinetobacter infections in the Intensive Care Unit (ICU