CIC Practice Exam 3

CIC Practice Exam 3 revisit - revisit 2. The most unlikely method of transmission of infection in a healthcare setting would be: a. Airborne b. Vehicle c. Vector d. Contact - C Vector Rationale: Vectors, such as insects, may transmit infectious organisms in the healthcare setting; however, this method of transmission is of less importance in most industrialized nations. External vector-borne transmission is the mechanical transfer of microorganisms by a vector, such as a fly on ood. Internal vector-borne transmission involves transfer of infectious material directly from the vector into the new host, such as occurs in mosquitoes and malaria, fleas and plagu, and louse-borne typhus. The vector may simply harbor the infectious organism, with no biological interaction taking place, or the agent may actually undergo changes within the vector (e.g., malaria parasites require that part of their life cycle take place within a mosquito). 3. After an incident in which human milk from one mother was mistakenly fed to another mother's infant, the infection preventionist (IP) is tasked with leading a team to determine why the event occurred and how it can be prevented from happening again in the future. This type of analysis is known as: a. Root cause analysis (RCA) b. Gap analysis c. Strengths-weaknesses-opportunities-threats (SWOT) analysis d. Failure mode effect analysis (FMEA) - A Root cause analysis Rationale: RCA, gap analysis, SWOT analysis, and FMEA are tools that can be used to improve quality. The RCA process takes a retrospective look at adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring. Gap analysis is a tool that is used to take an organization from a current state to a future state where organizational objectives are met. A SWOT analysis is a process where the organization or group assesses their own positive and negative points, outlines opportunities for improvement and growth, and lists any threats that might impede those opportunities. A FMEA ca 4. Which one of the following best describes the difference between a common point source outbreak and a propagated outbreak? a. Case fatality rates in common source outbreaks are higher b. Person-to-person transmission is a feature of common source outbreaks c. The attack rate in propagated outbreaks is higher d. All cases in a common point source outbreak occur within one incubation period of the exposure - D All cases in a common point source outbreak occur within one incubation period of the exposure Rationale: A common source epidemic is characterized by a rapid spread with cases presenting at the same stage of the disease, indicating the single source of the pathogen. Propagated outbreaks are outbreaks in which the disease propagates in one or more initial cases and then spreads to others, a relatively slow method of spread. 5. Which of the following aid in the diagnosis of pseudomembranous colitis (PMC)? 1) Colonoscopic biopsy of lesions 2) Raised antibody levels in blood to Clostridium difficil toxin 3) Positive blood culture for Clostridium difficil 4) Stool assays for Clostridium difficil a. 1, 2 b. 2, 3 c. 3, 4 d. 1, 4 - D 1, 4 Rationale: Pseudomembranous colitis (PMC) is an acute colitis characterized by the formation of an adherent inflammatory membrane (pseudomembrane) overlying sites of mucosal injury. Clostridium difficil infection is responsible for the majority of cases of PMC and for as many as 20 percent of cases of antibiotic-induced diarrhea without colitis. The method of choice fore establishing the diagnosis is done by stool assays for C. difficil toxins or by colonoscopy. 6. A patient is admitted with fever, nausea and vomiting, sensitivity to light, and stiff neck. Symptom onset has been progressing slowly over several weeks. The Gram stain of the cerebrospinal fluid CSF) is India ink positive, and there is low glucose and predominant lymphocytes. What type of precautions is required for this patient? a. Standard plus Droplet Precautions b. Standard Precautions c. Standard plus Airborne Precautions d. Standard plus Contact Precautions - B Standard Precautions Rationale: Cryptococcosis is the most common fungal infection of the central nervous system. Cryptococcal meningitis is caused by the fungus Cryptococcus neoformans. This fungus is found in soil around the world. Cryptococcosis is believed to be acquired by inhalation of the fungus from the environment. Unlike bacterial meningitis, this form of meningitis comes on more slowly, over a few days to a few weeks. India ink will stain the polysaccharide capsule of C. neoformans, and C. neoformans meningitis is characterized by low glucose in the CSF and predominant lymphocytes. These results allow fungal meningitis to be distinguished from (1) bacterial meningitis, which is characterized by fairly normal glucose levels and predominant neutrophils; (2) viral meningitis, which is stain negative with normal glucose; and (3) mycobacterial meningitis, which is AFB-stain positive. Meningitis with C. neoformans is not communicable so only Standard Precautions are needed in this case. 7. How can streptococci be differentiated from staphylococci under the microscope following the Gram stain procedure? a. Staphylococci are Gram positive cocci, while streptococci are Gram positive bacilli b. Staphylococci are Gram negative bacilli, while streptococci are Gram negative cocci c. Staphylococci are Gram positive, while streptococci are Gram negative d. Staphylococci are Gram positive and grow in grape-like clusters, while streptococci which are also Gram positive, grow in chains - D Staphylococci are Gram positive and grow in grape-like clusters, while streptococci, which are also Gram positive, grow in chains Rationale: Both staphylococci and streptococci have round, spherical cell shapes, but the arrangement of cells is different due to a different binary fision. Streptococci form a chain of round cells, because their division occurs in one linear direction, while staphylococci divide in various directions forming grape-like clusters. Both are facultatively anaerobic gram-positive bacteria. 8. Frequency histograms and polygons are most useful for variables of what level of measurement? 1) Interval scale 2) Ratio scale 3) Nominal scale 4) Ordinal scale a. 1, 2 b. 1, 3 c. 2, 3 d. 3, 4 - A 1, 2 Rationale: A histogram is a graphic of a frequency distribution in which one bar is used for each time interval, and there is no space between the intervals (see Figure PE3-1). It is used to portray the (grouped) frequency distribution of a variable at the interval or ratio level of measurement. 9. Which of the following is the correct order for disinfecting endoscopes? a. High-level disinfection, rinse the scope with sterile water, flush the channels with 0 to 90 percent alcohol, dry using forced air b. Rinse the scope using sterile water, high-level disinfection, flush the channels with 0 to 90 percent alcohol, dry using forced air c. Flush the channels with 70 to 90 percent alcohol, rinse the scope using sterile water, high-level disinfection, dry using forced air d. Dry using forced air, high-level disinfection, flush the channels with 70 to 90 percent alcohol, rinse the scope using sterile water - A High-level disinfection, rinse the scope with sterile water, flushthe channels with 70 to 90 percent alcohol, dry using forced air Rationale: Cleaning is essential before manual or automated disinfection. Thoroughly clean the entire endoscope immediately after use, then completely immerse the endoscope and endoscope components in the high-level disinfectant/sterilant and ensure that all channels are perfused. After high-level disinfection, rinse the endoscope and flush the channels with sterile, filered, or tap water to remove the disinfectant/sterilant. Discard the rinse water after each use/cycle. Flush the channels with 70 to 90 percent ethyl or isopropyl alcohol and dry using forced-air. The final drying teps greatly reduce the possibility 10. The lead IP is invited to participate in an employee health process improvement project. The goal of the project is to improve influenza accination rates among employees. A multidisciplinary team is formed with representation from front-line employees. After conducting a root cause analysis (RCA), the team develops a proposal for improvement to present to the facility leadership team. Which of the following elements should be included as part of the proposal to most clearly communicate to the leadership team the factors contributing to the facilities' current vaccination rate among employees? a. A timeline for implementing improvement activities b. A Pareto chart c. A fishbone diagram with an explanation d. A strategic plan - C A fishbone diagam with an explanation Rationale: The RCA process takes a retrospective look at adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring in the future. The product of the RCA is an action plan that identifies the trategies that the organization intends to implement to improve safety. A thorough RCA demonstrates credibility of the recommended process to the facility leadership team. When used during the RCA process, a fishbone diagam (also called an Ishikawa diagram) will help identify and visually display both the elements involved in the improvement project and the areas of responsibility and accountability (see Figure PE3-3). Used in conjunction with the RCA, the fishbone diagram with an accompanying explanation present a clear picture of the both improvement project and rationale behind it. 11. An IP wants to make external comparisons of the data collected relating to catheter-associated urinary tract infections (CAUTI) in the Intensive Care Unit (ICU). Which of the formulas below will allow the IP to accurately benchmark against nationally available data? a. The number of ICU patients with urinary catheters in a given month divided by the number of urinary tract infections identified in the same month times 1000 b. The number of ICU urinary tract infections identified in a given month divided by the number of urinary catheter days in the same month times 1,000 c. The number of urinary catheters used in the ICU in a given month divided by the number of urinary tract infections identified in the same month times 1000 d. The number of urinary tract infections identified in a given month divided by the total number of patient days in the ICU in the same month times 1,000 - B The number of ICU urinary tract infections identified in a given month divided by the number of urinary catheter days in the same month times 1,000 Rationale: Data should be expressed as rates or ratios that are calculated using the same methodology as a nationally validated surveillance system. This allows an organization to compare its rates with another organization or a recognized benchmark. The NHSN indicator for CAUTI measures the development of a urinary tract infection associated with