CIC Exam Study Guide Correct 100%

Type I error - Answer Rejecting null hypothesis when it is true Type II error - Answer failing to reject a false null hypothesis cohort study - Answer Follows a group of people to track risk factors and outcomes overtime Groups are defined regarding their EXPOSURE to a factor of interest. (perspective or longitudinal studies) Followed-up to determine differences in rates at which disease develops in relation to exposure. Start with a sample of individuals with and without EXPOSURE to a potential risk factors who are followed for incidence of the outcome in each group. They can also be done retrospectively. Cohort studies have less patient selection and stronger evidence of causal association. Yields incidence rates, relative risk, attributable risk More EXPENSIVE Case-control study - Answer Compares histories of a group of people with a condition to a group of people without the condition. Begins with the identification of individuals who have the OUTCOME of interest. After case-control status is defined, exposures are assessed and evaluated. Good for studying rare outcomes or outcomes that develop over a long time. Determine if two groups differ in exposure. (Case reference, case comparison. Or retrospective studies) Examine the population of individuals with and without an outcome of interest, study for exposure to one or more risk factors. The studies are quicker, less expensive, and easier. Generally yields only estimate of relative risk (odds ratio). Example: Foodborne illness investigations cross-sectional study - Answer Assesses the prevalence of an outcome in a broad population at one point in time. Provide a "snapshot" of a population at a moment in time. Point Prevalence. (Prevalence, correlation or survey studies) Exam in the outcome and risk factors reviewed in a population group at one point in time. In the studies the outcomes are measured the incidence rate cannot be determined. case reports/series - Answer Detailed history of a small number of individual cases quasi-experiment - Answer Non-randomly assigned groups of patients to receive either a treatment or placebo Randomized-controlled trial - Answer Randomly selects a group of patients to receive a treatment and Another to receive placebo systematic review and meta-analysis - Answer Collects all previous studies on the topic and statistically combined their results Sensitivity - Answer The ability of a test to detect ALL TRUE cases of the disease. = (Number of true-positive results) / (the number of true-positive + false-negative results) High sensitivity = High False Positives. High sensitivity = TRUE NEGATIVES. You will not have any false negative tests. Specificity - Answer The ability of a test to correctly identify a negative result. = (Number of true-Negative results) + (Number of False-Positive results) High Specificity = TRUE POSITIVES. you will not have any false positive tests. High chance for false negatives. Positive Predictive Value (PPV) - Answer TP/(TP+FP) Negative Predictive Value (NPV) - Answer TN / (TN + FN) Bacterial meningitis CSF analysis - Answer Cloudy Increased neutrophils Increased Protein Decreased Glucose Increased WBC Viral meningitis CSF analysis - Answer Clear/hazy Normal to increased protein Normal to decreased glucose Normal to increased WBC Normal to increase lymphocytes Normal to increased monocytes Normal to decreased neutrophils Fungal meningitis CSF analysis - Answer Clear/hazy Increase WBC's Normal to increase protein Normal to decreased glucose Normal to increase lymphocytes Normal to increased monocytes Normal to decreased in neutrophils Increased Agglutination capacity Gram- negative bacteria - rods/bacilli - Answer K. pneumoniae E. coli P. aeruginosa A. baumannii Which of the following groups have a similar cell structure that is known as "prokaryotic" A. Virus B. Fungi C. Bacteria D. Parasites - Answer C. Bacteria There are at least 17 groups of bacteria according to one classification scheme that is based in large part on nucleotide sequences of RNA. All of these groups have a similar cell structure that is known as "prokaryotic". Prokaryotic cell structure is microscopically characterized by lack of a visible nucleus, by the lack of a membranous nuclear envelope, and by lack of a membrane bound internal structure such as mitochondria. A patient comes into the emergency department complaining of pain in the genital Area with a history of unprotected sexual contact. The nurse practitioner wants to rule out trichomonas vaginalis. What type of test will be ordered? A. Wet mount B. Gram stain C. Blood culture D. Cytological exam - Answer A. Wet mount Specimens routinely collected for wet mount include sputum Viewed for fungal elements; stool examined for larvae, adult worms, ovum, cysts, or parasites; cerebral spinal fluid for cryptococcus neoformans; vaginal secretions for trichomonas vaginalis; and urine sediment for white blood cells, bacteria, yeast, and parasites (T. vaginalis). The emergency department has seen an increase in patients with complaints of diarrhea, fever, abdominal cramps and vomiting. An investigation reveals all of the patients went to a holiday chili cook off three days ago and ate from vendor X. Choose the most likely culprit: A. Salmonella spp B. Clostridium botulinum C. Listeria monocytogenes D. Staphylococcus aureus - Answer A. Salmonella spp Most persons infected with salmonella bacteria develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually last 4 to 7 days, and most persons recover without treatment. Diplococcus - Answer pair of cocci. The diplococcus (plural diplococci) is a round bacterium (coccus) that typically occurs in the form of two joined cells. Examples of gram-negative diplococci: Neisseria sp., Moraxella catarrhalis, Acinetobacter, and Brucella An example of pneumonia generally acquired from an environmental source is: A. Legionella B. Pneumococcal C. Meningococcal D. Varicella - Answer A. Legionella Legionella is a type of bacterium found in naturally in freshwater environment, like lakes and streams. It can become a health concern when it grows and spreads in human made water systems like: Showers and Fossetts Cooling towers for air-conditioning units in large buildings Hot tubs that aren't drained after each use Hot water tanks and heaters Large plumbing systems Fecal oral spread of hepatitis a virus is an example of A. Direct contact transmission B. Indirect contact transmission C. Droplet transmission D. Vehicle transmission - Answer A. Direct contact transmission Hepatitis A is a liver disease caused by the hepatitis a virus. The hepatitis a virus is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. Direct contract transmission occurs when there is physical contact between an infected person and a susceptible person. Epidemiologic triangle of Disease causation - Answer Consists of: 1. an external agent, 2. a susceptible host, 3. in an environment that brings the host and agent together. Minimum inhibitory concentration (MIC) - Answer The lowest concentration of an anti-microbial drug that will inhibit the visible growth of a micro organism after overnight incubation. The hospital is at 100% occupancy in the IP is consulted regarding cohorting of patients. Which of the following pairs would be the safest to cohort? A. A new post operative knee replacement patient and a patient with an infected decubitus ulcer that was recently debriefed. B. A patient with AIDS and a patient receiving chemotherapy C. A newly admitted patient with influenza and a patient with pneumonia who is originally admitted with influenza four days ago. D. A premature neonate in a full-term healthy baby born the same day. - Answer C. A newly admitted patient with influenza and a patient with pneumonia who is originally admitted with influenza four days ago. The first option is incorrect as a potential exists for the new knee to become infected from the decubitus ulcer. The second choice is incorrect as the patient with AIDS could have an opportunistic infection which could infect the immuno suppressed patient. The last choice is incorrect as a premature neonate are more vulnerable to organisms that the healthy baby might be colonized with. When interpreting the HICPAC/CDC System for categories and recommendations, which category is strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. A. Category IA B. Category IB C. Category IC D. Category II - Answer A. Category IA The optimal positioning of a patient to prevent ventilator associated pneumonia is A. Supine B. Semirecumbent C. Probe D. Sim's position - Answer B. Semirecumbent Five key components for the VAP bundle: 1. Elevate the head of the bed to 45° when possible; otherwise, attempt to maintain the head of the bed at more than 30° 2. Evaluate readiness for extubation daily 3. Use endotracheal tube's with subglottic secretion drainage 4. Conduct oral care and decontamination with chlorhexidine 5. Initiate safe enternal nutrition within 24 to 48 hours of ICU admission A patient is admitted to the ED with a diagnosis of severe sepsis. Which of the following elements of the sepsis bundle must be completed within three hours of presentation? 1. Measure lactate level 2. Apply vasopressors 3. Administer 30 ml/kg crystalloid for hypotension or lactate >=4mmol/L 4. Measure central venous oxygen saturation (ScvO2) A. 1,2 B. 2,3 C. 3,4 D. 1,3 - Answer D. 1,3 The severe sepsis three hour resuscitation bundle contains the following elements, to be completed within 3 hours of the time of presentation with severe sepsis: Measure lactate level Obtain blood cultures prior to administration of antibiotics Administer broad-spectrum anabiotic's Administer 30 ml/kg crystalloid for hypotension or lactate >=4mmol/L The 6- hour septic shock bundle contains the following elements, to be completed within 6 hours of the time of presentation with severe sepsis: Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation to maintain a mean arterial pressure (MAP) >=65 mm Hg) In the event of persistent arterial hypertension despite volume resuscitation (septic shock) or initial lactate >=4 mmol/L (36 mg/dL): Measure central venous pressure Measure of central venous oxygen saturation Remeasure lactate if initial lactate was elevated The IP is preparing Data for entry into NHSN. Which of the following is correctly classified as clean-contaminated (class II)? A. Emergency splenectomy in a 10-year-old female with ideal pathic thrombocytopenic purpura (ITP) B. Elective thoracotomy with upper lobe ectomy in a 48-year-old smoker. C. Perforated diverticulum and a 50-year-old female. D. Closed reduction of the Smiths fracture in an 82-year-old male - Answer B. Elective thoracotomy with upper lobe ectomy in a 48-year-old smoker. Clean contaminated or class II surgical wounds may involve entry into part of the body that normally contain flora, such as respiratory or urinary tract; however, in order to qualify as a class II, such procedures must be elective and do not violate aseptic technique nor show evidence of an infectious process. The elective thoracotomy with upper lobe resection involves the respiratory tract, a potential source of contamination. However, surgery was elective and did not show infection or break in technique, so is correctly classified as a clean contaminated Which of the following patient should be assigned to an airborne infection isolation room? A. A patient with a tracheostomy who has bronchitis. B. A patient with Guillain-Barré syndrome who is on a ventilator. C. A patient with an undetermined cause of pneumonia who has AIDS. D. A patient with community acquired pneumonia who is having copious respiratory secretions. - Answer C. A patient with an undetermined cause of pneumonia who has AIDS. People with aids are at high risk for opportunistic infection such as TB. Worldwide, TB is the most common opportunistic infection affecting HIV-seropositive individuals, and it remains the most common cause of death in patients with AIDS. You are revising the disaster plan with the emergency management committee of your hospital. What should be the primary focus of this plan? 1. Preparing for a surge of causalities in case of a disaster. 2. How to identify risks for disaster. 3. How to prevent disasters from occurring. 4. How to reduce disaster impact on patients and staff. A. 1,2 B. 2,3 C. 3,4 D. 1,4 - Answer D. 1,4 The joint commission requires hospitals to plan how emergencies will be managed; must be documented in the emergency operations plan (EOP). The goals of a hospital preparedness/disaster plan are to: Enhance surge capacity response Ensure ability to maintain services in a sustained event. Collaboration and integration of plans with all emergency response partners Options two and three are outside the scope of a hospital EMC plan Ideal temperature for DPT storage is: A. 2 to 8 degrees Celsius B. 16-20 degrees Celsius C. 8-12 degrees Celsius D. Room temperature - Answer A. 2-8 degrees Celsius Store diphtheria, tetanus, and pertussis vaccines are refrigerated between 2°C and 8°C. Do not freeze vaccine, or exposed to freezing temperatures. If the vaccine has been exposed to inappropriate conditions/temperatures or handled improperly, store the vaccine at the appropriate temperature, isolate from other vaccines, mark "do not use", and consult the vaccine manufacture and/or your state or local immunization program for guidance. An infection Preventionist would like to compare best practices from the APIC guide to preventing central line associated bloodstream infections with current facility processes to determine what steps should be taking to help reduce CLABSI events. Which of the following tools would best help the IP to achieve this goal? A. Root cause analysis B. Strategic plan C. Gap analysis D. Failure mode effects analysis - Answer C. Gap analysis A gap analysis can be defined as the determination of the difference between current knowledge/practices (What we are doing) And current evidence-based practices (what we should be doing). Gaps can occur in knowledge, skills or practice. Human factors engineering is the discipline of applying what is known about human capabilities and limitations to the design of A. Organizing, planning, leading, controlling B. Products, processes, systems, work environment C. Directing, goalsetting, decision-making, resource allocation D. Hardware, software and operating system interfaces - Answer B. Products, processes, systems, work environments Human factors is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order To optimize human well-being and overall system performance. You are the infection prevention manager and are using the evidence-based practice process to reduce CAUTI rate in your ICU. You meet with the unit staff nurses for input. Which question would you post to the staff to reflect the first step of the EBP process? A. What is the exact clinical issue with which we are dealing? B. Is anyone prepared to evaluate the statistics we will find? C. What outcomes are we expecting from this work? D. Where can we look for information? - Answer A. What is the exact clinical issue with which we are dealing? The evidence-based practice process has five steps: 1. Ask important questions about the care of individuals, communities, or populations. 2. Acquire the best available evidence regarding the question. 3. Critically appraise the evidence for validity and applicability to the problem at hand. 4. Apply the evidence by engaging in collaborative health decision making with the affected individuals and/or groups. Appropriate decision making it integrates the context, values and preferences of the care recipient, as well as available resources, including professional expertise. 5. Assesses the outcome and disseminate the results. An increase in the number of CLABSI events are noted in the oncology ward during the last quarter. The IP speaks to the oncology staff, reviews the charts, and observes central line management practices on the unit. This scenario is best reflected by which quality tool? A. Root cause analysis B. Fishbone C. Strengths, weaknesses, opportunities, and threats D. Ishikawa diagram - Answer A. Root cause analysis Root cause analysis is a process for identifying the basic or causal factors underlying variation in performance. A root cause analysis focuses primarily on systems and processes, not individual performance. Developing a vision and mission, identifying and organizations external opportunities and threats, and determining enternal strengths and weaknesses are all a part of which of the following activities? A. Strategy formulation B. Strategy implementation C. Long range planning D. Short range planning - Answer A. A strategy formulation Strategy formulation is the process by which an organization chooses the most appropriate course of action to achieve is to find goals. This process is essential to an organization success, because it provides a framework for the actions that will lead to the anticipated results. Strategic plan should be communicated to all employees so that they are aware of the organizations objectives, mission, and purpose. Strategy formulation force is an organization to carefully look at the changing environment and to be prepared for the possible changes that may occur. Strategic plan also enables an organization to evaluate its resources, allocate budgets, and determine the most effective plan for maximizing return on investment. If an IP would like to describe the beliefs of nurses who would be expected to care for victims of a pandemic influenza, which research design would be conducive to understanding how nurses perceive this phenomenon? A. Cohort B. Case-control C. Mixed methods D. Qualitative - Answer D. Qualitative Qualitative research is primarily exploratory research. It is used to gain an understanding of underlying reasons, opinions, and motivations. It provides insight into the problem or helps to develop ideas or hypothesis for potential quantitative research. It may also be used to uncover trends in thoughts and opinions. An IP wants to increase awareness of best practices regarding common infection prevention in fractions during the care process. Which instructional method could be used to deliver this training? A. Simulation B. Educational cart C. Positive deviance D. Case studies - Answer A. Simulation Simulation-based education provide students with opportunities to practice their clinical and decision making skills through various real life situational experiences. The advantages of simulation-based education interventions include the ability to provide immediate feedback, repetitive practice learning, the integration of simulation into the curriculum, the ability to adjust the difficulty level, opportunities at individualized learning, and the adaptability to the first types of learning strategies A study design in which a population of individuals with and without exposure to a potential risk factor are identified and followed to compare the incidence of the outcome in each group would be: A. Cohort B. Case control C. Descriptive D. Analytical cross sectional - Answer A. Cohort A study design where one or more samples (cohorts) are followed prospectively and subsequent status evaluations with respect to the disease or outcome are conducted to determine which initial participants exposure characteristics (risk factors) are associated with it. As the study is conducted, outcomes from participants in each cohort is measured in relationships with specific characteristics determined. A critical review of the message section of a published study should include all the following except: A. Is the time period of the study appropriate? B. If controls are used, are they comparable to the cases? C. Is the study design described in enough detail and applicable to the purpose of the study? D. are the potential limitation and weaknesses describe? - Answer D. Are the potential limitations and weaknesses described? Limitations and weaknesses of the study should be described in detail in the discussion section. Do you have identified cases of Stenotrophomonas maltophilia In the respiratory secretions of patients in the ICU. After conducting a preliminary review, which of the following sources as most likely? A. Showerheads B. Shallow, automatic sink with aerator C. New waterless baiting system e.g. warm pipes D. Contaminated respiratory equipment - Answer B. Shallow, automatic sink with aerator Various study section on the aerators may be contaminated by Graham negative bacteria including P. aeruginsoa, S. maltophilia, B. cepacia, and A. calcoaceticus. Aerators contaminated with bacteria have been epidemiological linked to colonized or infected patients. An appropriate agent to select when performing high level disinfection would be A. Phenolic B. Quaternary ammonium compound C. Chlorine based product D. 2% glutaraldehyde - Answer D. 2% glutarldehyde Glutarldehyde based agents are used to disinfect medical equipment that cannot be subject to steam sterilization, specifically heat sensitive, lens device is typically requiring high level disinfection between patient uses. Phenolic disinfectants - Answer Powerful tuberculocidal disinfectants. They are a form of formaldehyde, have a very high pH, and can damage the skin and eyes. Not recommend for use in an infant nursery. High-level disinfection - Answer kills all microorganisms except spores and prions. Equipment that comes in contact with mucous membranes Dash such as respiratory therapy and anesthesia equipment, G.I. endoscopes, bronchial scopes, and laryngoscope blades must receive high level disinfection. 5.25% sodium hypochlorite - Answer Household bleach disinfectant. It has a broad spectrum of antimicrobial activity. It is effective against hepatitis B virus and HIV. It is a fast acting disinfectant. Quaternary Ammonium Compounds (Quats) - Answer Disinfectant that is considered nontoxic, odorless, and fast-acting. Glutaraldehyde - Answer Environmental Protection Agency (EPA)-registered high-level disinfectant. I design meeting is reviewing the new layout of the preparation and packing area in a sterile processing department. What important information should the IP bring to the meeting? 1. Minimum of 8 air exchange as per hour 2. Surgical pack assembly room should maintain positive airflow 3. Humidity issue between 30 and 60% 4. Return air registers should be at or near ceiling level. A. 1,2 B. 2,3 C. 3,4 D. 1,4 - Answer B. 2,3 Sterilization , preparation, packaging and sterile storage are considered clean areas and should have positive airflow ventilation. Soiled and decontamination areas should be under negative pressure. Each area should have a minimum of 10 air exchanges per hour. Humidity should be between 30 and 60%. Return air registers shall be at rear floor level, thereby facilitating the installation and effective maintenance of any filtering systems. Micro organisms are grown on culture media made of an agar base. Additives to media vary according to growth requirements of organisms and or the desire to select out a specific organism. Fastidious organisms required enrichment media. Which media is used to inhibit normal commensals? A. Synthetic sheep blood agar B. Selective C. Enrichment D. Differential - Answer B. Selective Select media are used for the growth of only selected micro organisms. For example, if a micro organism is resistant to a certain type of antibiotic, such as ampicillin or tetracycline, then the anabiotic can be added to the medium in order to prevent other cells, which do not possess the resistance, from growing. Media lacking in amino acids such as protein in conjunction with E. coli unable to synthesize it were commonly used by geneticist the for the emergence of genomics to map bacterial chromosomes. Selective growth media are also used in cell culture to ensure the survival or proliferation of cells with certain properties, such as antibiotic resistance or the ability to synthesize a certain metabolite. Normally, the presence of a specific gene or an allele of a gene conferred upon the cell the ability to grow in a selective medium. In such cases, the gene is termed a marker. Selective growth media for eukaryotic cells commonly contain neomycin to select cells that have been successfully transfected with a plasmid carrying the neomycin resistant gene as a marker. Gancyclovir is an exception to the rule as it is used to specifically kill cells that carry its respective marker, the herpes simplex virus thymidine kinase. Enrichment Growth Media - Answer Chocolate agar, for hard to grow bacteria selective media - Answer suppress growth of unwanted bacteria (or flora) and encourage growth of desired microbes. Differential media - Answer make it easy to distinguish colonies of different microbes. Promotes specific organisms. A 38-year-old woman being treated for breast cancer has a WBC count of 2.3. This is an improvement over the counts seen during the past two weeks. Her physician has been aggressive in treating every potential infection she has had. She is currently on an antibiotic for a bloodstream infection from staphylococcus epidermidis. She now has a fever of 100.4°F. What action should be taken? A. Her intervenous side should be inspected frequently. B. None because she may have a neutropenic fever and no real infection. C. More blood cultures because she may be developing a fungal septicemia. D. Antibiotics stopped because she may have a "drug fever" - Answer C. More blood cultures because she may be developing a fungal septicemia. Sepsis (staphylococcus and fungi) is the leading cause of mortality in neutropenic cancer patients. Early initiation of affective causative therapy as well as intensive adjunctive therapy is mandatory to improve outcome. Blood cultures as a part of the usual microbiological work up remain the gold standard for the diagnosis of bacteremia. Steps for an outbreak investigation - Answer 1. Establish the existence of an outbreak 2. Verify the diagnosis 3. Define and identify cases. 4. Describe and orient the data in terms of time, place, and person. 5. Develop hypotheses 6. Evaluate hypothesis 7. Refine hypothesis and carry out additional studies 8. Implement control and prevention measures 9. Communicate findings Communication and collaboration with relevant personnel during an outbreak situation is essential. The first cases to be recognized may only be a small portion of the total number. An important early step is to review aspergillus cultures to determine the extent of the outbreak. APIC text chapter 12 - outbreak investigation The IP is reviewing the chart of a patient with a sputum culture positive for pathogens. Which of the following findings indicates that the specimen had been properly collected from a patient with possible bacterial pneumonia? A. Presence of Blood B. Variety of both gram-positive and gram-negative bacteria. C. Many epithelial cells and few neutrophils. D. Numerous neutrophils and few if any epithelial cells. - Answer D. Numerous neutrophils and few if any epithelial cells. Useful sputum culture results rely heavily on good sample collection. If examination of a Gram stain of the sample reveals that it contains a significant number of normal cells that line the mouth (squamous epithelium cells), then the sample is not generally considered adequate for culture and a recollection of the sample may be required. If the sample contains a majority of neutrophils that indicates a body's response to an infection, then it is considered to be an adequate sample for culturing. APIC Text ch 24 artifactual association - Answer Artifactual association is a false association that can be due to chance or bias in a study method indirect association - Answer Indirect association is the mixing of effects among exposure, disease, and a third factor (e.g. a confounding variable) that is associated with the exposure and independently affect the outcome. causal association - Answer Causal association is said to exist when the evidence indicates that a factor clearly increases the probability of the occurrence of a disease and reduction of this factor decreases the frequency of the disease. Steam sterilization (autoclave) - Answer Uses steam under pressure to obtain high temperature of 250-254F with exposure times of 20-40 minutes defending on the item being sterilized. Kills bacterial spores and all other micro organisms. Can only be used for items that are tolerant of high temperatures. ethylene oxide - Answer gas used to sterilize surgical instruments and other supplies. Gas sterilization is a low heat method for items that are not heat tolerant. Must be allowed time for aeration prior to use. Qualitative Research Examples - Answer Participant observation, Focus groups, interviews, field notes, and tape recordings or transcriptions. Descriptive statistics - Answer Descriptive statistics refers to data analysis that helps describe, show, or summarize the data in a meaningful way such that patterns may emerge from the data. Descriptive statistics do not allow us to make any conclusions beyond the data analyze or reach conclusions regarding any hypothesis we might have made. They are simply a way to describe the data. Inferential statistics - Answer In case of any parental statistics, we begin by differentiating between two groups. The population is the entire collection of individuals that we are interested in studying. It is often possible to examine each member of the population individually. Instead, we can choose a representative subset of the population called a sample. Inferential statistics studies a statistical sample, and is able to say something about the population from which the sample came, on the basis of this analysis. Discrete data - Answer Discrete data contains whole numbers and are mutually exclusive. Examples: infected or not infected, male or female, and blood type Continuous data - Answer Continuous data contains information that can be measured on a continuum scale and can have numeric value between the minimum and maximum value (a continuum). Examples: age, serum cholesterol level, temperature, infection rates Normal distribution - Answer Normal distribution is when the values on both sides of the main or even. It is a bell shaped curve. The mean, median, and mode are all equal. One standard deviation is 68.2%. Two standard deviations is 95.5%. And three standard deviations is 99.7% Skewness (negative and positive) - Answer Skewness is asymmetrical distribution. Negative Skew: Elongated tail at the left. More data in the left tail then will be expected in a normal distribution. Positive Skew: Elongated tail at the right. More data in the right tail then will be expected in the normal distribution. Kurtosis - Answer Ketosis represents how flat or peaked a curve is shaped. Measure of the fatness of the tails of a probability distribution relative to that of a normal distribution. Indicates likelihood of extreme outcomes. Rate - Answer Rate = (x/y)k X = the numerator, which equals the number of times the event (i.e. an infection) has occurred during a specific time interval. Y = The denominator, which equals a population (ie number of patients at risk) K = A constant that we used to transform the results of the division into a uniform quality. All numbers such as 100, 1000, or 100,000 are often used. Incident Rate Formula - Answer = ((#of new cases)/ (population at risk))x100 Incident density formula - Answer = ((#of new cases)/(exposure time x device days))x100 Incorporate time into the denominator. Example: in February there at 8 new cases a ventilator associated pneumonia in ICU. We want to be able to understand that number as a portion of the total number of days that patients were on ventilators. There were 24 patients on the ventilator that month and each was on mechanical ventilation for three days. The number of ventilator days equals 24×3 = 72. The VAP rate per 1,000 vent days = (8/72)x1,000 = 111 Relative Risk (RR) - Answer = [a/(a+b)]/[c/(c+d)] Use 2x2 table odds ratio - Answer = ad/bc p-value - Answer The P value or calculated probability is the estimated probability of rejecting the null hypothesis (Ho) of a study question when that hypothesis is true. Small p-value (<0.05) = indicates strong evidence against the null hypothesis, so you reject the null hypothesis. " if the P is low, the Ho has got to go" Large p-value (>0.05) = indicates weak evidence against the null hypothesis, so you failed to reject the null hypothesis. p-value close to cutoff (0.05) = consider to be marginal (could go either way). Mortality rate - Answer = (#of deaths/population at risk)x100,000 Example in 2006, the resident population of New Mexico is estimated at 2,010,787. The total number of deaths in New Mexico during the 2006 calendar year was 15,231. Crude mortality rate equals (15,221÷2,010,787)×100,000 = 757.5 resident deaths per 100,000 population in 2006 in New Mexico. Standardize infection ratio (SIR) - Answer SIR = (# Observed) / (# Predicted) What organisms are the most common cause of bacterial coinfection with Influenza? - Answer 1. Staphylococcus aureus 2. Streptococcus pneumoniae 3. Streptococcus pyogenes What are rare complications of Influenza? - Answer 1. Encephalitis 2. Transverse myelitis 3. Reye's Syndrome 4. Myositis 5. Myocarditis 6. Pericarditis 7. Renal Failure Which Influenza strain is predominantly the cause of pandemics? - Answer Influenza A strain - 2009 H1N1 and 1819 Pandemic Which Influenza strain is associated with annual epidemic diseases? - Answer Influenza B - however, the clinical illness tends to be milder than illnesses caused by Influenza A. Which Influenza strain is associated with 13% of all influenza infections? - Answer Influenza C Produces mild illness, usually a "common cold" or are detected with another respiratory virus, which makes it difficult to assess its clinical role. What are common reservoirs for Influenza A? - Answer Swine and poultry What is the alternative vaccine for individuals who have mild to severe allergic reactions to eggs? - Answer Recombinant Influenza Vaccine (RIV) A comprehensive influenza infection prevention plan includes what four components? - Answer 1. Early identification and isolation of patients. 2. Annual education about influenza and the benefits of vaccination for HCP and patients. 3. Restricting ill patients and HCP 4. Hand hygiene as well as vaccination of HCP. What are the 3 common Prion Diseases? - Answer CJD, Kuru, and GSS Syndrome What are the three types of CJD cases? - Answer Sporadic, Familial, and Iatrogenic What is the most common type of CJD? - Answer Sporadic - 85-95% of all cases What are the six clinical characteristics of CJD? - Answer 1. Rapid and progressive dementia. 2. Ataxia 3. Myoclonic seizures 4. Visual or sensory deficits 5. Abnormal psychiatric behavior 6. Coordination deficits What is the average time frame of symptom onset to time of death for someone with CJD? - Answer 7-9 months What is the definitive way to diagnose CJD? - Answer Direct examination of brain tissue. Utilizing a Western blot assay. Routine diagnostic tests are rarely of value in making a diagnosis of CJD. What are the 4 effective types of disinfectant available for CJD? - Answer 1. Chlorine 2. Phenol 3. Guanidine thiocyanate 4. Sodium hydroxide Chlorine is the most readily available disinfectant and provides the most consistent prion inactivation. However, the corrosive nature of chlorine makes it unsuitable for semi-critical devices, such as endoscopes. What are the most important measures to prevent Respiratory Syncytial Virus (RSV) from spreading within a healthcare facility? - Answer 1. Hand Hygiene 2. Standard and Droplet Contact Precautions 3. Cohorting 4. Rapid diagnostic techniques RSV is apart of which virus family? - Answer Paramyxovirus family What is the mode of transmission for RSV? - Answer Direct contact with nasal droplets from infected individuals or by indirect contact with contaminated hands or fomites. Which subgroup of RSV is more prominent? - Answer Subgroup A How long is the incubation period for RSV? - Answer 2-8 days What are the clinical features of RSV? - Answer Upper Respiratory tract infection Including: 1. Sneezing 2. Rhinorrhea 3. Nasal Congestion 4. Fever Progression to the lower respiratory tract disease may result in bronchiolitis, tracheobronchitis, and pneumonia. What are the 3 most common bacterial agents associated with foodborne illness in the United States? - Answer 1. Salmonella spp. (11%) 2. Clostridium perfringens (10%) 3. Campylobacter spp. (9%) What are the 4 leading causes of hospitalizations associated with foodborne illnesses? - Answer 1. Nontyphoidal Salmonella spp (35%) 2. Norovirus (26%) 3. Campylobacter spp. (15%) 4. Toxoplama gondii (8%) What are the 4 leading causes of death associated with foodborne illnesses? - Answer 1. Nontyphoidal Salmonella spp (28%) 2. Toxoplama gondii (24%) 3. Listeria monocytogenes (19%) 4. Norovirus (11%) Foodborne illness: Campylobacter jejuni - Answer Incubation Period = 2-5 days Signs & Symptoms = Diarrhea, cramps, fever, and vomiting; diarrhea may be bloody. Duration = 2-10 days Food Sources = Raw and undercooked poultry, unpasteurized milk, contaminated water Foodborne illness: Clostridium perfringens - Answer Incubation Period = 8-16 hours Signs & Symptoms = Intense abdominal cramps, watery diarrhea Duration = usually 24 hours Food Sources = Meats, poultry, gravy, dried or precooked foods, time and/or temperature-abused foods Foodborne illness: Listeria monocytogenes - Answer Incubation Period = 9-48 hrs for gastrointestinal symptoms, 2-6 weeks for invasive disease Signs & Symptoms = Fever, muscle aches, and nausea or diarrhea. Pregnant women may have mild flu-like illness, and infection can lead to premature delivery or stillbirth. The elderly or immunocompromised patients may develop bacteremia or meningitis Duration = Variable Food Sources = Unpasteurized milk, soft cheeses made with unpasteurized milk, ready-to-eat deli meats Foodborne illness: Salmonella Spp. - Answer Incubation Period = 6-48 hours Signs & Symptoms = Diarrhea, fever, abdominal cramps, vomiting Duration = 4-7 days Food Sources = Eggs, poultry, meat, unpasteurized milk or juice, cheese, contaminated raw fruits and vegetables Foodborne illness: Staphylococcus aureus - Answer Incubation Period = 1-6 hours Signs & Symptoms = Sudden onset of severe nausea and vomiting. Abdominal cramps. Diarrhea and fever may be present Duration = 24-48 hours Food Sources = Unrefrigerated or improperly refrigerated meats, potato and egg salads, cream pastries Foodborne illness: Yersinia enterocolitica - Answer Incubation Period = 24-48 hours Signs & Symptoms = Appendicitis-like symptoms (diarrhea and vomiting, fever, and abdominal pain). Duration = 1-3 wk, usually self-limiting Food Sources = Undercooked pork, unpasteurized milk, tofu, contaminated water. Infection has occurred in infants whose caregivers handled chitterlings. Foodborne illness: Norovirus - Answer Incubation Period = 12-48 hrs Signs & Symptoms = Nausea, vomiting, abdominal cramping, diarrhea, fever, headache. Diarrhea is more prevalent in adults, vomiting more common in children Duration = 12-60 hrs Food Sources = Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters Foodborne illness: E. coli (producing toxin) - Answer "Traveler's Diarrhea" Incubation Period = 1-3 days Signs & Symptoms = Watery diarrhea, abdominal cramps, some vomiting. Duration = 3-7 or more days Food Sources = Water or food contaminated with human feces. Foodborne illness: Toxoplasma gondii - Answer Incubation Period = 5-23 days Signs & Symptoms = Generally asymptomatic; 20 percent may develop cervical lymphadenopathy and/or a flulike illness. In immunocompromised patients, central nervous system (CNS) disease, myocarditis, or pneumonitis is often seen. Duration = Months Food Sources = Accidental ingestion of contaminated substances (e.g., soil contaminated with cat feces on fruit and vegetables), raw or partly cooked meat (especially pork, lamb, or venison). Passed from mother (who acquired acute infection during pregnancy) to child.