CIC Exam Study Cards 2024

CIC Exam Study Cards 2022 Type I error Rejecting null hypothesis when it is true Type II error failing to reject a false null hypothesis 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 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 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 Detailed history of a small number of individual cases quasi-experiment Non-randomly assigned groups of patients to receive either a treatment or placebo Randomized-controlled trial Randomly selects a group of patients to receive a treatment and Another to receive placebo systematic review and meta-analysis Collects all previous studies on the topic and statistically combined their results Sensitivity 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 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) TP/(TP+FP) Negative Predictive Value (NPV) TN / (TN + FN) Bacterial meningitis CSF analysis Cloudy Increased neutrophils Increased Protein Decreased Glucose Increased WBC Viral meningitis CSF analysis 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 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 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 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 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 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 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 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 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 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) 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. 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 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 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 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 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. 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 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 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 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 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? 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 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 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 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 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 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? 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 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 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 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 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 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) Disinfectant that is considered nontoxic, odorless, and fast-acting. Glutaraldehyde 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 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 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 Chocolate agar, for hard to grow bacteria selective media suppress growth of unwanted bacteria (or flora) and encourage growth of desired microbes. Differential media 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" 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 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. 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 Artifactual association is a false association that can be due to chance or bias in a study method indirect association 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 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) 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 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 Participant observation, Focus groups, interviews, field notes, and tape recordings or transcriptions. Descriptive statistics 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 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 Discrete data contains whole numbers and are mutually exclusive. Examples: infected or not infected, male or female, and blood type Continuous data 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 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) 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 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 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 = ((#of new cases)/ (population at risk))x100 Incident density formula = ((#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) = [a/(a+b)]/[c/(c+d)] Use 2x2 table odds ratio = ad/bc p-value 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 = (#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) SIR = (# Observed) / (# Predicted) What organisms are the most common cause of bacterial coinfection with Influenza? 1. Staphylococcus aureus 2. Streptococcus pneumoniae 3. Streptococcus pyogenes What are rare complications of Influenza? 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? Influenza A strain - 2009 H1N1 and 1819 Pandemic Which Influenza strain is associated with annual epidemic diseases? 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? 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? Swine and poultry What is the alternative vaccine for individuals who have mild to severe allergic reactions to eggs? Recombinant Influenza Vaccine (RIV) A comprehensive influenza infection prevention plan includes what four components? 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? CJD, Kuru, and GSS Syndrome What are the three types of CJD cases? Sporadic, Familial, and Iatrogenic What is the most common type of CJD? Sporadic - 85-95% of all cases What are the six clinical characteristics of CJD? 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? 7-9 months What is the definitive way to diagnose CJD? 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? 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? 1. Hand Hygiene 2. Standard and Droplet Contact Precautions 3. Cohorting 4. Rapid diagnostic techniques RSV is apart of which virus family? Paramyxovirus family What is the mode of transmission for RSV? Direct contact with nasal droplets from infected individuals or by indirect contact with contaminated hands or fomites. Which subgroup of RSV is more prominent? Subgroup A How long is the incubation period for RSV? 2-8 days What are the clinical features of RSV? 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? 1. Salmonella spp. (11%) 2. Clostridium perfringens (10%) 3. Campylobacter spp. (9%) What are the 4 leading causes of hospitalizations associated with foodborne illnesses? 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? 1. Nontyphoidal Salmonella spp (28%) 2. Toxoplama gondii (24%) 3. Listeria monocytogenes (19%) 4. Norovirus (11%) Foodborne illness: Campylobacter jejuni 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 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 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. 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 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 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 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) "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 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. What are 7 common risk factors for MRSA infection among patients in healthcare settings? 1. Prior exposure to antimicrobial agents 2. Prolonged hospital stay 3. Stay in ICU or Burn Unit 4. Proximity to patients colonized or infected with MRSA 5. Use of invasive devices 6. Surgical Procedures 7. Underlying illnesses What are the 5 organisms known to be able to penetrate the intact epithelium of the conjunctiva or cornea? 1. Neisseria gonorrhoeae 2. Neisseria meningitidis 3. Streptococcus pneumoniae 4. Listeria monocytogenes 5. Corynebacterium diptheriae Toxic anterior segment syndrome (TASS) Acute, sterile inflammation following anterior segment surgery of the eye. What parasites are most commonly associated with healthcare-associated transmission? Scabies, lice, and maggots. How long can mites survive on cloth furniture or stuffed animals? 3 days How long is the incubation period for a primary infestation of mites? As early as 10 days, but typically 4-6 weeks. Patients with reinfestation, symptoms usually appear within 1-3 days. What is the clinical presentation of a mites infestation? Burrow-type pruritic lesions on hands, webs of fingers, wrists, and extensor surfaces of elbows and knees, as well as outer surfaces of feet, armpits, buttocks, and waist. Which of the following organisms is most likely to be associated with contaminated disinfectants? A. Pseudomonas species B. Hepatitis C C. Clostridium difficile D. Cryptosporidium parvum A. Pseudomonas species Always store disinfectants per IFUs. Diluted bleach solutions stored in an open container must be changed every: A. 28 days B. 24 hours C. 12 hours D. after every use B. 24 hours If cleaning is done manually, the two essential components are___________ and _______________. Friction and fluidics Which of the following is the correct order for disinfecting endoscopes? A. High level disinfection, rinse scope with sterile water, flush the channels with 70-90% alcohol, dry using forced air. B. Rinse the scope using sterile water, high level disinfection, flush the channels with 70-90% alcohol, dry using forced air. C. Flush the channels with 70-90% 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 70-90% alcohol, rinse the scope using sterile water. A. High level disinfection, rinse scope with sterile water, flush the channels with 70-90% alcohol, dry using forced air. Which of the following must be documented when using soaking solutions for cleaning instruments? 1) Monitoring the temperature of the solution 2) Monitoring the room temperature 3) Monitoring the humidity of the room 4) The time the instruments soaked A. 1,2 B. 2,4 C. 3,4 D. 1,4 D. 1,4 Monitoring the temperature of the solution and The time the instruments soaked An IP recommends that CHG be used to prepare a site for the insertion of a PICC because it: 1) Requires only 30 seconds to dry 2) Can be used for all ages 3) Is not associated with allergic reactions 4) Can be easily rinsed after the line is inserted A. 3,4 B. 1,3 C. 2,3 D. 1,4 B 1,3 Requires only 30 seconds to dry and Is not associated with allergic reactions. CHG does not need to be removed or rinsed from the skin. CHG is not approved for use with infants younger than 2 months of age Performance Improvement Performance improvement is an ongoing continuous cycle that focuses on patient clinical outcomes, customer satisfaction, and service. Examples: PDSA Cycle The Strategic Plan Determines the direction an organization will go in the future and what the organization must do in order to reach the goal, mission, or vision. Steps: 1. An analysis of the organization 2. Forming conclusions about what an organization must do as a result of issues facing the organization. 3. Action planning Gap Analysis A technique used to compare best practices with the current process and determine the steps to take to move from a current state to a desired FUTURE STATE. What is -> What should be -> Identifying "gaps" "use your inner eye to see the future" - Hermione Granger Root Cause Analysis RCA 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. Information Collection: through structured interview, document reviews, and field observations. Avoids individual blame, considers human factors engineering, and analyzes redesign for a safer system. "7:30, where were we at 7:30?" - Hermione Granger Going back in time to save buckbeak Which of the following are considered to reduce the chance of transmission of Neisseria meningitidis to laboratory personnel. 1. Surgical mask 2. Gown and Gloves 3. Biosafety cabinet (BS-2) 4. N95 mask and gloves 5. Immunization A. 1,2,3,4,5 B. 2,3,4,5 C. 1,2,3,5 D. 2,3,4 C. 1,2,3,5 Rationale: Transmission to laboratory workers is also a concern and reinforces the importance of masks, gowns, and gloves with manipulating secretions or potential aerosols, biosafety cabinet (BS-2) precautions for working with cultures of N. meningitidis, and immunization of microbiology laboratory personnel. In 2002, the CDC reported two cases of fatal laboratory-associated meningococcal disease that occurred in microbiologists who handled clinical specimens of N. meningitis serogroup C. This meningococcal disease occurring in the preceding 15 years through a Listserv survey. The overall fatality rate in this series was 50%. Fishbone or Ishikawa Diagram This is an efficient way of problem solving by isolating specific components and deconstructing positive or negative consequences through an investigatory lens. Often used after a RCA is completed. Failure Mode and Effects Analysis (FMEA) a systematic process for identifying potential design and process failures before they occur, with the intent to eliminate them or minimize the risk associated with them Primary prevention. What is the correct diagnosis for a patient with the following lab results: HBsAg: + Total Anti-HBc: + IgM Anti-HBc: - Anti-HBs: - A. Susceptible, never infected B. Acute, resolving infection C. Past infection, recovered and immune D. Chronic infection D. Chronic infection HBsAg: + = Positive for Surface antigen = either by exposure or vaccination Total Anti-HBc: + = Positive for Core antibodies = from infection IgM Anti-HBc: - = Negative for currently making anti-bodies for the core Anti-HBs: - = Negative for antibodies for the surface antigen HBsAg: if this is positive, that means you currently have an infection (regardless of acute or chronic) IgG-HBsAg: if this is positive, you have won the battle; either you are Cured or Vaccinated SWOT Analysis Strengths, Weaknesses, Opportunities, Threats Utilized to investigate public health issues and improve healthcare outcomes. Conducting this type of analysis points out what the organization should plan for, and how to use resources and guide efforts within a formal framework. Goal-Directed Checklist enhance patient safety/quality of care by following a very prescriptive checklist. SSI Prevention check list Run Charts type of chart used to show variations in the process over time or to show trends (such as improvements or the lack of improvements) in the process. Demonstrate special cause variation when tere is a steady pattern of observation points falling aboce or below the mean average. Affinity Diagrams used to generate ideas that can be linked to form organized patterns of thought about a problem Sticky notes that are then split into categories Pareto Charts a graphic way of classifying problems by their level of importance, often referred to as the 80-20 rule. What is the biggest bang for your buck? Focus on the vital few that will give you the most benefits Six Sigma Minimize process variation which produces defects. Which of the following refers to patient harm that is the result of treatment by the healthcare system rather than from the health condition of the patient? A. Adverse event B. Dire consequence C. Unanticipated event D. Sentinel event A. Adverse Event The Director of Infection Prevention and Control is leading a process improvement project to decrease the rates of CLABSIs in one of the hospital's ICUs. The multidisipanary team has discussed multiple process improvement strategies to decrease these blood stream infections. In developing the final improvement plan which of the choices below is most likely to help decrease the rates of these infections? A. Performing a gap analysis each moth. B. Performing a Failure Mode Effect Analysis immediately C. Incorporating the use of a CLABSI bundle and checklist to ensure that all aspects of the plan are followed D. Perform a SWOT analysis. C. Incorporating the use of a CLABSI bundle and checklist to ensure that all aspects of the plan are followed. In 1997, the Joint Commission on Accreditation of Healthcare Organization (TJC) mandated the use of root cause analysis to: A. Document instances of medical malpractice B. Predict the occurrence of an incident C. Improve Staffing issues D. Investigate sentinel events in accredited hospitals D. Investigate sentinel events in accredited hospitals A sentinel event is defined by the TJC as an event that results in loss of life, limb, or mental stability from an adverse event within the hospital. The purpose of root cause analysis is to: A. Determine which individual made an error so that the employee may be disciplined or terminated. B. Review the basic processes that are in place and then turn that review over to a unit-specific team so that they can determine how they should modify their practices. C. Provide a process that requires little time or training but allows employees to identify culpability after an adverse event. D. Include participants from diverse areas of the organization to delve into the cause of an error or systems failure and identify changes in practice and/or policy that will prevent repeat of that error. D. Include participants from diverse areas of the organization to delve into the cause of an error or systems failure and identify changes in practice and/or policy that will prevent repeat of that error. After reviewing the quarterly report, the manager of the adult ICU contacts the IP for assistance to create a plan to reduce central line infections. Which of the following should the IP recommend: A. Wait for next report to see if the rate has decreased B. Create an intravascular Team C. Develop a multidisipanary team to review and implement best practices D. Send a referral to Medical Affairs for peer review C. Develop a multidisipanary team to review and implement best practices The Director of the Infection Prevention and Control Department has assigned one of her IPs to cofacilitate in a root cause analysis of an adverse event in collaboration with the Performance Improvement team. The IP plans to use process improvement tools and techniques during the analysis. Which of the following methods would best outline the possible causes of the event? A. Brainstorming B. Affinity diagrams C Fishbone diagram D. Pareto chart C Fishbone diagram What 5 bacteria are known to transform into endospores? Bacillus antracis - anthrax Clostridium tetani - tetanus Clostridium defficile - c diff Clostridium perfringens - gas gangrene Clostridium botulinum - botulism Gram- Positive bacteria cell wall Contains lipoteichoic acid Large/thick peptidoglycan wall Gram Stain Procedure 1. Primary stain - Crystal violet- both cell walls affix the dye 2. Iodine Gram +: Dye complex trapped in wall Gram -: No effect of iodine 3. decolorizing agent - Ethanol or acetone Gram +: Crystals remain in cell wall Gram -: Ourter membrane weakend; wall loses dye 4. Counterstain -Safranin Gram +: Red dye masked by violet Gram -: Red dye stains the colorless cell In a gram stain procedure, Gram-positive bacteria stain purple because: A. They have lipopolysaccharide layer in their cell wall that is decolorized with alcohol B. Their cell walls contain long-chain fatty acids that take up crystal violet easily C. They have a thick peptidoglycan cell wall that retains the primary stain during the alcohol decolorization D. Gram-staining is simple staining so the only stain used is crystal violet C. They have a thick peptidoglycan cell wall that retains the primary stain during the alcohol decolorization lipopolysaccharide = gram (-) = Red Long-chain fatty acids = acid fast bacteria Simple staining = safranin as well You have isolated a bacterium from your skin. Chemical analysis shows that it contains proteins, peptidoglycan, lipids, DNA, and teichoic acid. What sort of bacteria is this? A. Gram-Positive B. Gram-Negative C. Cannot tell from this information D. Non-bacterial entity A. Gram-Positive Acid-fast Bacteria Mycobacteria Contain mycolic acid = cord factor (VLCFA) long chains of fatty acid. Waxy surface impervious to chemicals or dyes. Important Pathogens: TB Leprosy Opportunistic wound infections Grow inside of macrophages Mycobacterium spp Nocardia Actinomyces organisms Acid-Fast Stain 1. apply primary stain- carbolfuchsin for 30 seconds 2. Heat fix cells to slide using flame 3. decolorize with acid-alcohol 15-20 seconds -non acid-fast bacteria decolorize, acid-fast remain pink 4. Apply counterstain- methylene blue (30 s) rinse w/ h20 -provides contrast entre acid-fast and background material -acid-fast are pink, non acid-fast are blue Calcofluor White Stain Used to stain fungus, yeast, molds Wet mount specimens and pathogens Specimens: Sputum, drainage from leasons, body fluid aspirates, stool, vaginal discharge and urine sediment. Pathogens: Motile trophozoites of Giardia lamblia in stool, Trichomonas vaginalis in vaginal discharge or urine sediment, and Entamoeba histolytica from liver abscess aspirate. Nutrient agar growth media Supports the growth of a wide variety of bacteria. TSA - Trypticase soy agar with 5% sheep's blood Enrichment medium growth media Contains special nutrients necessary for growth of fastidious bacteria hard to grow bacteria Chocolate agar utilized for the growth of Neisseria meningitidis Selective media growth media Contains chemicals or antibiotics designed to inhibit normal commensal bacteria. Bismuth sulfate agar for the isolation of Salmonella spp. Differential Media growth media Stains colonies of specific organisms, while inhibiting the growth of others. Acetate agar to differentiate between E. Coli from Shigella Obligate Aerobes Only aerobic growth, oxygen required Facultative Anaerobes Both aerobic and anaerobic growth; greater growth in presence of oxygen Obligate Anaerobes only anaerobic growth; ceases in presence of oxygen NO OXYGEN Aerotolerant Anaerobes Only anaerobic growth; but continues in presence of oxygen Microaerophiles Only aerobic growth; oxygen required in low concentration A microbe that can grow in the absence of oxygen, but is also able to utilize oxygen for growth is a/an: A. Aerobe B. Obligate anaerobe C. Facultative anaerobe D. Microaerophilic anaerobe C. Facultative anaerobe Microorganisms are grown on culture media made of an agar base. Additive to media vary according to growth requirements of organism and/or the desire to select out a specific organism. Fastidious organisms require _____________ media, and _____________ media is used to inhibit normal commensals. 1. Differential 2. Enriched 3. Selective 4. Nutrient broth 5. Synthetic sheep blood agar A. 1,3 B. 2,3 C. 5,1 D. 3,4 B. 2,3 Fastidious organisms require Enriched media, and Selective media is used to inhibit normal commensals. Fastidious organisms require Enrichment media. Which media is used to inhibit normal commensals? A. Differential B. Enriched C. Selective D. Synthetic sheep blood agar C. Selective An example of a selective media that inhibits Gram-positive bacteria is: A. Sabouraud agar B. Chocolate agar C. Typticase Soy agar D. MacConkey's agar D. MacConkey's agar Catalase Test and Coagulase Test Catalase - Used to differentiate between streptococci (negative) and Staphylococci (positive) Coagulate - used to differentiate S. aureus from other Staphlyocooi such as S epidermidis (negative) What are the 5 steps required for specimen collection and transport? 1. Specimens should be collected aseptically, placed in a sterile container. 2. Some specimens may be placed directly on culture media (eg blood cultures, genital cultures) 3. Special handling techniques may be necessary for some specimens (eg anaerobic cultures) 4. Prompt delivery essential 5. If transport is delayed, some specimens may be refrigerated (eg urine, stool, sputum); others should be maintained at room temperature ( eg genital, eye, spinal fluid). The Director of the Operating Room (OR) requests that the OR surfaces be routinely environmentally cultured. The IPs 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 culturing should not be considered unless an epidemiologic investigation is being conducted. D. Routine culturing should not be considered unless an epidemiologic investigation is being conducted. Important considerations regarding blood culture specimens should include: 1. Collect prior to the initiation of antimicrobial therapy 2. Collect from a central venous catheter whenever possible 3. Ensure that the volume of the specimen collected is sufficient 4. Culture of specific sites is not recommended for surveillance A. 1,3 B. 2,4 C. 1,4 D. 3,4 A. 1,3 You receive a call from a young man who thinks he was exposed to HIV. His baseline HIV test (ELISA) was negative. At what time period after exposure would we be most likely to detect HIV antibodies? A. 1 to 3 months B. 3 Weeks C. 6 Months D. 12 months A. 1 to 3 months The window period for HIV A physician orders a culture, ova and parasite specimen on a 10 y/o boy admitted with diarrhea. A liquid stool specimen is collected from the patient at 9pm. The specimen is refrigerated until 9am the next day when the physician calls and requests the lab to look for amoebic trophozoites. The best course of action is to: A. Perform a trichome stain on the original specimen B. Request a fresh specimen C. Perform a concentration on the original stool specimen D. Perform a saline wet mount on the original specimen B. Request a fresh specimen Patients with cell-mediated immunity dysfunction are susceptible to infections attributed to pathogenic intracellular bacteria. Examples of these organisms include: 1. Salmonella typhi 2. Bacteroides fragilis 3. Listeria monocytogenes 4. Staphylococcus aureus A. 3,4 B. 1,2 C. 1,3 D. 2,3 C. 1,3 An example of an obligate intracellular parasitic bacterium would be an organism responsible for: 1. Hepatitis 2. Q fever 3. Malaria 4. Chlamydia A. 2,3 B. 2,4 C. 3,4 D. 1,2 B. 2,4 Which of the following specimens can remain at room temperature after collection if transport to the lab will be delayed? A. Sputum B. Urine C. Stool D. Cerebral spinal fluid (CSF) D. Cerebral spinal fluid (CSF) - only for 1 hour What is the ranking (high to low) for Cost and Time for each research study design: Cohort Case-Control Cross-Sectional Cohort = High Case-Control = Low Cross-Sectional = Low What is the size (large or small) of subjects/population required for each research study design: Cohort Case-Control Cross-Sectional Cohort = Large Case-Control = Small Cross-Sectional = Large Which research study design is suitable for rare exposures? Cohort Which research study design is suitable for rare outcomes? Case-control Which research study design is very likely to be impacted by recall bias? Case-control What is the completeness of information (high, low, full) for each research study design: Cohort Case-Control Cross-Sectional Cohort = High Case-Control = Low Cross-Sectional = Full, but only cross-sectonal What is the assessment of temporal relationship for each research study design: Cohort Case-Control Cross-Sectional Cohort = Good Case-Control = Difficult Cross-Sectional = Not possible What is the changes in the characteristics of the subjects in each research design: Cohort Case-Control Cross-Sectional Cohort = More likely Case-Control = Less Likely Cross-Sectional = None What is the loss to follow-up for each research study design: Cohort Case-Control Cross-Sectional Cohort = More Case-Control = Less Cross-Sectional = None Loss to follow-up bias Refers to patients who at one point in time were actively participating in clinical research trial, but have become lost at the point of follow-up in the trial Odds ratio AD/BC Attributable Risk AR=IE-IU Attributable risk (AR) is the risk difference between exposed and unexposed groups. In equation form it is: = Risk(exposed)−Risk(unexposed) = [A/(A+B)]−[C/(C+D)] It is the quantity of disease that one could hope to avoid by removal of the risk factor in question. SSI Surveillance: Organ/ Deep for 90 Days includes which procedures Craniotomy and CABG SSI Surveillance period: Superficial incision 30 days for all procedures Process Measure focuses on a process that leads to a certain outcome. Used to evaluate compliance with desired care or support practices. Examples: medication errors, influenza vaccination rates in personnel, TB Skin test, Hand Hygiene, Outcome Measure A measure that indicates the result of the performance (or nonperformance) of a function or process. Examples: HAIs, influenza or TB skin test conversions, patient falls, sharps injuries Surveillance The collection of data with the ultimate objective of dissemination of that data to support and improve public health activities. Superficial SSI 1. The infection must occur within 30 days of the operation AND involve only the skin or subcutaneous tissue. 2. Purulent drainage 3. Organism growth from the drainage AND 4. Superficial opening of the incision by the surgeon OR pt has pain or s/s of infection, or diagnosis of SSI by surgeon, attending, or designee. Attributable Risk (AR) = incidence exposed - incidence unexposed = (a/(a+b)) - (c/(c+d)) standard deviation Measure of dispersion.. Descriptive statistic that describes the variability of the values around the mean. 1 standard deviation = 68.2% 2 standard deviations = 95.4% 3 standard deviations = 99.7% Specificity of a test for infection or disease is calculated as: The number of TRUE Negatives divided by the total number of persons WITHOUT disease, x 100 Specificity = (True Neg. / Total # without Disease)100 Attributable Risk Percent The percentage of a disease that could be prevented by eliminating the exposure in the study population. = (AR/Incidence Exposed)*100 =((a/(a+b)) - (c/(c+d)) / (a/(a+b))) *100 The most common reservoir for highly pathogenic avian influenza H5N1 visurs is: a. Migratory birds b. Pigeons and Doves c. Water fowl d. Domestic poultry d. Domestic poultry Which of the following statements is true when the prevalence of a disease is very low? a. The sensitivity of a diagnostic test is greatly increased. b. The specificity of a di