CBIC exam with 100% correct answers 2024.

Define administrative controls. Give an example - ANSWER-the use of administrative measures like enforcement measures, policies and procedures that are designed to reduce the risks of pathogenic transmissions in the health care setting. An example of an administrative control is a policy and procedure related to the disposal of sharps and other bio-hazardous waste. Define aerosols.What are they most commonly produced by? - ANSWER-small particles less than 10 µm that can remain airborne and viable for extended periods of time in the environment. Aerosols are most commonly produced and generated by things like water and air syringes. Define airborne transmission. - ANSWER-the mode and means of transmission for a pathogen that is airborne and then possibly inhaled by the host as droplet nuclei. What is alcohol-based hand rub? - ANSWER-an alcohol-containing preparation designed for reducing the number of viable microorganisms on the hands. These rubs are not a substitute for good hand washing and they are only to be used when hand washing facilities and materials are not available. What is an allergen? - ANSWER-an antigen which can cause hypersensitivity and an allergic reaction in the host. Hosts can have sensitivity to medications, foods and other environmental sources like toxins. Define allergic contact dermatitis. Give examples of things that can cause it. - ANSWER-swelling or irritation of the skin that results from contact with a chemical. It is often localized to the area of the body that touched the contaminated item, which occurs slowly over twelve to forty eight hours after direct contact. Some examples of chemicals that can lead to allergic contact dermatitis include latex or another component in gloves, as well as plants like poison ivy and poison oak. What is anaphylaxis? What are the signs and symptoms? - ANSWER-a severe and life threatening allergic response that occurs during exposure to an allergen like penicillin, latex in gloves and some pollens. The signs and symptoms of anaphylaxis are hives, itching, respiratory problems, anaphylactic shock, coma and in some cases, death. What is the difference between the first and second dose of anaphylaxis? - ANSWER-The first exposure or dose is referred to as the sensitizing exposure or dose the second exposure or dose is the one that leads to anaphylaxis, or anaphylactic shock. Define antibodies. - ANSWER-proteins in the blood produced as the result of exposure to an antigen or pathogen. Antibodies bind to antigens and destroy them. Define antigens. - ANSWER-a protein or carbohydrate substance that enters the body and activates the immune process by stimulating the production of protective antibodies. What is antiseptic? Give examples. - ANSWER-a germicidal solution that can be used to inhibit the growth of microorganisms, including pathogens, or to destroy it. Some examples of antiseptics hexachlorophene, iodine, alcohol and antiseptic hand washes. Define asepsis. What are the two types of asepsis? - ANSWER-a method used to prevent the spread of infection. The two types of asepsis are medical asepsis, or clean procedure, and surgical/sterile asepsis. What is bacterial count? What unit of measurement does it use? - ANSWER-an estimation of the number of organisms in a unit of measurement. Bacterial counts are usually determined in terms of colony-forming-units per square centimeter/ per milliliter. What is bio-burden? What is it also referred to as? - ANSWER-the number of viable microorganisms on a surface or an object prior to decontamination and/ or sterilization. Bio-burden is also referred to as microbiological load, microbial load and bio-load. What are biological indicators? - ANSWER-devices used to monitor the effectiveness of sterilization processes, in terms of whether these processes effectively destroy microorganisms and spores. Define blood-borne pathogens and give examples. - ANSWER-disease-producing pathogens that are spread and transmitted to others via contact with blood and other bodily fluids. Some examples of blood-borne pathogens are HIV and hepatitis. What is the Blood-borne Pathogens Standard? - ANSWER-a legal and binding regulation mandates that all employers protect their staff from occupational exposures to infectious agents and pathogens. What are chemical indicators? - ANSWER-a device used to monitor the effectiveness of sterilization processes in terms of whether these processes meet the rigors of effectiveness. Chemical indicators change their color or their form when they are exposed to sterilization temperatures and pressures. These indicators, like biological indicators, can alert personnel that there has been an error or malfunction in terms of packaging, cleaning, decontamination, sterilizer loading and a breakdown of the equipment itself. What can chemical sterilants destroy? - ANSWER-all microorganisms and bacterial spores. Define cleaning. - ANSWER-the physical, manual removal of visible material from a device or surface using scrubbing, water, and a detergent or a surfactant. Define colony-forming unit (CFU). How are CFUs expressed as a unit of measurement? - ANSWER-the minimum number of separable cells on or in an agar that creates a colony. A colony can be comprised of single cells, clusters of cells, chains and pairs of cells. These units of measurement are expressed as colony-forming-units per milliliter, or CFU / ml. What does contaminated mean? When is a sterile item contaminated? A clean item? - ANSWER-Having been in contact with a microorganism. Sterile items are contaminated when sterile technique is not scrupulously followed. Clean or medically aseptic items are contaminated when they have not been managed and handled in a manner that preserves medical asepsis. What are critical medical devices? Give examples. - ANSWER-medical instruments or devices used to enter the body or the bloodstream, both of which are sterile areas of the body. Critical medical devices are typically used for invasive procedures, all of which are risky in terms of the introduction of infection. Examples of critical medical devices are intravenous catheters, indwelling urinary catheters, scalpels and endoscopes. Define decontamination according to OSHA. - ANSWER-the use of physical or chemical means to remove, inactivate, or destroy blood-borne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. Define direct contact transmission. - ANSWER-a mode of transmission in which there is a physical transfer of microorganisms between a colonized or infected person and a host. What can disinfectants destroy? - ANSWER-Most pathogens, but not endospores. Define disinfection. - ANSWER-the destruction of microorganisms, including pathogens, using a chemical or physical means of disinfection. What are droplet nuclei? - ANSWER-minute particles less than 5 µm diameter that can be transported and carried in the air for relatively long periods of time. What are droplets? - ANSWER-small particles of moisture from sprays and splatters. Some examples of droplets include particles propelled when a person coughs or sneezed and particles that are spread with a splatter of blood. Droplets do not last as long as droplet nuclei in the air, therefore, they are less hazardous in terms of transmission most typically affect those in close proximity to the source spray or splatter. What are endotoxins? - ANSWER-the lipopolysaccharides of gram-negative bacteria that can lead to pyrogenic reactions. Define engingeering controls, and give examples. - ANSWER-like administrative and work practice controls, aim to prevent the transmission of healthcare pathogens and infections. Some examples of engineering controls include needleless systems and impervious labeled sharps disposal containers. What is event-related packaging? - ANSWER-the storage method that deems packages and contents sterile until some event, like moisture, saturates the item and renders it contaminated. What is exposure time? - ANSWER-the duration that an item is subjected to the disinfection or sterilization process. What is germicide? - ANSWER-An agent that destroys microorganisms including pathogens. Includes both antiseptics and disinfectants. What is the difference between antiseptic and disinfectant? - ANSWER-Antiseptics are used on human skin, and disinfectants are used on inanimate objects. What is Hepatitis B Immune Globulin (HBIG) used for? - ANSWER-provides artificial, passive, temporary immunity of about three to six months against the hepatitis B virus. What does elevated Hepatitis B Surface Antigen (HBsAg) indicate? - ANSWER-chronic or acute Hep B What does the presence of Hepatitis B e Antigen (HBeAg) indicate? - ANSWER-also found in chronic or acute Hep B, and is indicative of viral replication and increasing infection What is Hepatitis B Surface Antibody (anti-HBs), and what does its presence indicate? - ANSWER-the protective antibody against the hepatitis B virus (HBsAg). When this is present in the blood, it is indicative of a past infection, immunity to hepatitis B or an anticipated immune response after immunization with the hepatitis B vaccine. What is high-level disinfection? - ANSWER-the process of inactivating bacteria, mycobacteria, fungi, and viruses, but not large numbers of bacterial spores Define hypersensitivity. - ANSWER-an allergic immune response to an antigen. Define iatrogenic infections. - ANSWER-Infections and complications that result accidentally from a medical intervention or diagnostic procedure. Define active, passive, natural, and artificial immunity. - ANSWER-Active immunity occurs when antibodies are created in response to an antigen; passive immunity occurs when the fetus gets immunity from the mother in utero or rom t e injection of an immune globulin. Natural immunity occurs when the person develops antibodies to an infection because they have been infected with it; and artificial immunity is acquired when the person has received an immunization against the infection. Define indirect contact transmission. - ANSWER-the mode of transmission in which the host has contact with a contaminated inanimate object. Describe intermediate-level disinfection. - ANSWER-a disinfection process that, in contrast to high-level disinfection, deactivates vegetative bacteria, most fungi, mycobacteria, and most viruses, but not bacterial spores. Describe low-level disinfection. - ANSWER-a disinfection process that deactivates most vegetative bacteria, some fungi, and some viruses, but not resistant microorganisms (such as spores and mycobacteria). What are mechanical indicators? - ANSWER-sterilization devices like a gauge or meter that indicate, or display, the time, temperature and/or pressure during the sterilization process. Define medical regulated waste and give examples. - ANSWER-bio-hazardous waste that can cause infection without proper handling and disposal. Some examples of medical regulated waste include blood-soaked materials and sharp objects that have been used for surgery or another invasive procedure. Define noncritical medical devices and give examples. - ANSWER-medical items that pose the least amount of risk in terms of infection transmission when contrasted with critical medical devices. Some examples of noncritical medical devices include blood pressure cuffs and environmental surfaces such as floors and countertops. What is an occupational exposure? - ANSWER-the exposure of a healthcare worker to an infectious organism that occurs during the course of work. What are opportunistic infections? - ANSWER-Infections caused by a microorganism that does not ordinarily cause disease but is capable of doing so, under certain host conditions. Some of these conditions include HIV infection and other immunosuppressive diseases and disorders. What is a particulate respirator? - ANSWER-a respirator that is used to protect healthcare workers from airborne pathogens such as tuberculosis. NIOSH approved respirators are custom fitted, fit tested and maintained by the employer. Define prevalence. - ANSWER-the number of new and existing disease cases among members of a population during a given period of time. What are prions? - ANSWER-protein particles without nucleic acid that can lead to a number of neurological diseases like Creutzfeldt-Jakob disease and Scrapie. Define semi-critical medical devices. - ANSWER-medical devices or instruments that come into contact with mucous membranes, but do not enter internal areas of the body. What is seroconversion? - ANSWER-the production of antibodies by a person who had no prior detectable antibodies. What is Spaulding classification? - ANSWER-a category of medical devices and the degree of sterilization or disinfection that is needed. The three categories are critical medical devices, semi-critical medical devices and noncritical medical devices, as discussed above, that need three levels of high, intermediate, and low disinfection or sterilization, respectively. What are sterilants? - ANSWER-chemical germicides that destroy all forms of microbiological life, including high numbers of resistant bacterial spores. What does sterility mean? - ANSWER-free from all living microorganisms. In practice, usually described as a probability function (e.g., the probability of a surviving microorganism being 1 in 1,000,000) Define sterilization. - ANSWER-the destruction of all microorganisms and large numbers of bacterial spores with the use of a chemical or physical sterilizer. What are surfactants? - ANSWER-agents that clean surfaces by reducing surface tension, emulsifying and loosening debris. What are transient flora? - ANSWER-microorganisms that are in or on the body only with certain conditions and limited periods of time. What are transmission-based precautions? - ANSWER-special measures and practices to prevent the spread of infection based on the manner in which microorganisms are transmitted. These special measures are in addition to standard precautions. What are work practice controls? Give examples. - ANSWER-infection control preventive work practices that reduce the possibility of an occupational exposure to a pathogen. Some examples of work practice controls include the prohibition of recapping needles and the correct use of intravenous catheters. These controls, when incorporated into the everyday work routine, reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a twohanded technique). Describe the chain of infection. - ANSWER-Reservoir (humans, pond water, an animal)--> Agent (the microbe) --> Mode of transmission (direct contact, vector, vehicle, droplet, airborne) --> Susceptible host (also portal of entry and exit) Define pathogenicity. How is it quantified? - ANSWER-The ability of an agent to cause disease. The ratio of people who develop the disease out of total exposed. What is virulence? - ANSWER-How severe the microbe is. What is the infective dose? - ANSWER-the amount of the agent necessary to lead to infection Name the 5 agents of infection. - ANSWER-Bacteria, viruses, fungi, prions, parasites What are bacteria? - ANSWER-single-celled organisms classified by shape and morphology What shape are bacilli bacteria? - ANSWER-Rod-shaped Describe gram-positive vs gram-negative bacteria. - ANSWER-Gram-positive have thick walls containing teichoic acid and peptidoglycan; Gram-negative have thinner walls comprised of peptidoglycan and a lipid membrane What are the 4 phases of bacterial growth? - ANSWER-lag, log, stationary, and death Describe the lag phase of bacterial growth. - ANSWER-bacteria's acclimation to new environment; slow growth; high rate of biosynthesis Describe the log phase of bacterial growth. - ANSWER-exponential phase; rapid and continuous growth until nutrient(s) exhausted Describe the stationary phase of bacterial growth. - ANSWER-results from depletion of nutrients; halt in growth and metabolic activity Describe the death phase of bacterial growth. - ANSWER-end of bacteria's life; no nutrients left What are the components of viruses? - ANSWER-3 parts including DNA, RNA, and long molecules comprised of its genetic composition, protein coat, and outer coating of lipids How are viruses classified? - ANSWER-The host they can infect (plant viruses, fungal viruses, etc), shape, and nucleic acid composition/method of replication (DNA viruses, RNA viruses, and reverse transcribing viruses) What are the 6 stages of virus growth? - ANSWER-Attachment stage, penetration stage, uncoating phase, replication stage, self-assembly phase, and release of the virus Describe the attachment stage of virus growth. - ANSWER-when the virus attaches to a receptor on the host cell's surface Describe the penetration stage of virus growth. - ANSWER-virus enters the host's cell Describe the uncoating phase of virus growth. - ANSWER-removal of the viral capsid, allowing virus's nucleic material into the host cell Describe the replication stage of virus growth. - ANSWER-replication and multiplication of the genome Describe the self-assembly stage of virus growth. - ANSWER-maturation and modifications of the viral proteins Describe the release of the virus. - ANSWER-from host cells, with lysis How are fungi categorized when they affect humans? - ANSWER-superficial, cutaneous, subcutaneous, and systemic fungal infections Describe superficial fungal infections and give an example. - ANSWER-affects skin's epidermis and hair. Can often occur in healthy people. Ex: tinea capitis (ringworm) Describe cutaneous fungal infections and give an example. - ANSWER-invasive hair and nail infections beyond the epidermis. Ex: tinea pedis (athlete's foot) Describe subcutaneous fungal infections. - ANSWER-can infect all layers of the skin, the muscles, and fascia. Often result from deep puncture wounds Describe systemic fungal infections and give an example. - ANSWER-highly virulent, can spread to all organs of the body. Immunocompromised are at highest risk. Ex: aspergillosis, candiasis, and cryptococcosis What are prions? - ANSWER-an abnormal folding of normal cellular proteins that primarily affect the brain How are prions destroyed? - ANSWER-sterilization What are parasites? - ANSWER-an organism that lives in or on a host and gets food from or at the expense of a host What is giardia? How is it transmitted? What are the signs and symptoms? How is it treated? - ANSWER-microscopic parasite common in areas with poor sanitation and unsafe water; waterborne, also transmitted through food and person-to-person contact. S/S: watery and foul-smelling diarrhea, fatigue, malaise, abdominal cramps, bloating, nausea, weight loss, and belching gas with bad test. Typically last 2-4 weeks; Tx: mild cases resolve on their own, severe case treated with antibiotics How does tapeworm infestations occur? Describe invasive vs intestinal infestations. What are the signs and symptoms? How is it treated? - ANSWER-infestation occurs when food or water contaminated with eggs or larvae; invasive infection occurs when eggs migrate out of intestines and form cysts in bodily tissue and organs; intestinal infection is when an adult tapeworm develops in the intestines. S/S: intestinal tapeworms usually cause no signs or symptoms, but sometimes nausea, weakness, loss of appetite, abdominal pain, diarrhea, and weight loss; invasive infections can lead to tissue damage, symptoms including fever, allergic reaction to larvae, bacterial infections, cystic masses or lumps, and seizures; Tx: many types exit on their own; medications that are toxic to tapeworms include praziquantel, albendazole, and nitazoxanide; for invasive infections, anthelmintic drugs can be used to shrink the cyst; if the tapeworm is dying, anti-inflammatory therapy and corticosteroids What are pinworms? What are the signs and symptoms? How is it treated? - ANSWER-most common intestinal worm in U.S; S/S: itching of anus or vaginal area, insomnia, pain, and nausea; Tx: antiparasite medication often given to whole household What are lice? What are the signs and symptoms? How is it treated? - ANSWER-parasitic insects that feed on blood; S/S: intense itching and small red bumps on scalp, neck, and shoulders; Tx: special shampoo, benzyl alcohol lotion, or lindane What is myiasis? How is it treated? - ANSWER-maggot infestation; Tx: surgical removal, then site dressed and antibiotics given; cutaneous myiasis treated with thick coat of petroleum jelly, which robs the larvae of oxygen supply and moves them to the surface for easy removal; all types can be treated with oral or topical ivermectin What is scabies? What are the signs and symptoms? How is it treated? - ANSWER-itchy skin condition caused by Sarcoptes scabiei (a mite); contagious; S/S: itchiness, burrow tracks made up of tiny bumps on skin; Tx: meds such as permethrin 5% lindane or oral ivermectin What is a reservoir? - ANSWER-the environment or habitat where the pathogen lives, grows, and reproduces. Can include humans, animals, water, soil, and insects. What is the mode of transmission? What are the different modes? - ANSWER-allows a pathogen to move from its reservoir to its susceptible host; direct, indirect, airborne, vehicle, vector Describe direct transmission. - ANSWER-either direct contact with the pathogen or with an infected droplet Describe indirect transmission. - ANSWER-movement of an infectious agent from the reservoir to the host by an inanimate object Describe airborne transmission. - ANSWER-pathogen is carried in dust or droplets in the air that remain in place long enough to infect an exposed person. Ex: measles Describe vehicle transmission. - ANSWER-person comes in contact with an infectious product that's in water, blood, or other objects Describe vector transmission. - ANSWER-live beings (ex: ticks, mosquitoes) that spread infections by direct mechanical means, like an insect bite What are the 4 protective precautions? - ANSWER-Standard, contact, airborne, droplet What are standard precautions? - ANSWER-apply to all blood and bodily fluids, and all patients regardless of diagnosis What are contact precautions? - ANSWER-prevent any direct or indirect contact transmissions, like those contained in diarrhea, wounds, and herpes simplex What are airborne precautions? - ANSWER-prevent airborne transmission microbes (ex: TB); includes HEPA mask and negative pressure room What are droplet precautions? - ANSWER-prevent transmission from cough or sneeze. Masks What are the factors that affect a host's susceptibility? - ANSWER-age, heredity, level of stress, nutritional status, current medications and treatment, and diseases and other chronic conditions Define risk. - ANSWER-the probability that an infection will occur more often in one person or group than another What factors contribute to a person's risk of infection? - ANSWER-host susceptibility and exposure potential What are the two types of the body's defenses against infection? - ANSWER-Specific and non-specific Describe nonspecific defense against infection. - ANSWER-anatomical and physiological barriers to infection, and the inflammation process Describe specific defense against infection. - ANSWER-antibody mediated defenses (both active and passive immunity) and cell mediated defenses (AKA cellular immunity) What is active immunity? - ANSWER-production of antibodies in response to an antigen What is passive immunity? - ANSWER-when host receives antibodies from an artificial manner (ex: IVIG) or natural manner (ex: breastfeeding or in utero) What are the 3 levels of disease prevention? - ANSWER-Primary, secondary, tertiary What is primary prevention? - ANSWER-prevent the occurrence of infection, disease, and dysfunction before it occurs What is secondary prevention? - ANSWER-designed to identify infections and other diseases at the earliest possible time so that they can be treated What is tertiary prevention? - ANSWER-to return the affected individual, group, or population to the highest possible level of functioning after the correction of a health problem What affects the occurrence of infection? - ANSWER-increase in the number of infectious agents, increase in the virulence of the agent, enhanced mode of transmission, increase in the susceptibility of the host, and addition of new portals of entry and exit How is the occurrence of infection measured? - ANSWER-Rate, incidence, prevalence. Define rate. - ANSWER-the frequency of an event that occurs in a specific period of time, often in terms of a specific population. Ex: birth rate, death rate Define incidence. - ANSWER-the number of new events, such as infections, in a specific population in a defined period. The number of new events per 1,000/10,000/100,000 people. Ex: cumulative incidence rate, incidence density rate Define prevalence rate. - ANSWER-proportion where the numerator is the number of people with the infection, and the denominator is the number of people with the infection plus the number who are at risk for the infection Define epidemic. - ANSWER-an infectious disease occurrence that is greater than expected. Most common when there is a decrease in the host's immunity and/or increase in the agent's What is a common source outbreak? - ANSWER-AKA point source outbreak, occurs when those affected had a common exposure What is a propagated outbreak? - ANSWER-infection is not spread with a pathogenic agent; instead, spread from person-to-person contact Define pandemic. - ANSWER-like an epidemic but more widespread Define endemic. - ANSWER-the constant and continuous presence or an unusual presence of an infectious agent in a particular geographic location Define syndemic. - ANSWER-the combination of two diseases, or infections, that increases the negative effects of the two as they and the hosts interact within the environment Define incubation period. - ANSWER-the period of time that elapses between the initial exposure to the pathogen and the emergence of signs and symptoms What is a subclinical infection? - ANSWER-when a person can spread the infection, but have not yet had symptom onset Define latent period. - ANSWER-the time between infection and infectiousness What are the two categories of the incubation period? - ANSWER-intrinsic and extrinsic incubation What is intrinsic incubation? - ANSWER-marked by the time that the pathogen has had a chance to develop in the definitive host What is extrinsic incubation? - ANSWER-the amount of time it takes for the pathogen to completely develop in the intermediate host What are incubation periods impacted by? - ANSWER-individual variations, route of entry, exposure, the dose of the infectious agent, the host susceptibility to the pathogen, and rate of the infectious agent's replication Define period of communicability. - ANSWER-the duration of time that a pathogen can indirectly transmit an infection to another What are the stages of infection? - ANSWER-Incubation, prodromal, illness, and convalescence stages Describe the incubation stage of infection. - ANSWER-begins with the entry of the agent into the host and ends when signs and symptoms of the infection begin Describe the prodromal stage of infection. - ANSWER-begins with the onset of general symptoms and ends when infection-specific symptoms begin. It's during this stage when the pathogen is replicating and reproducing Describe the illness stage of infection. - ANSWER-period of time when specific symptoms begin, and continues until symptoms are no longer present Describe the convalescence stage of infection. - ANSWER-the period during which the symptoms disappear What initiates inflammation? - ANSWER-Tissue damage What are the goals of the inflammatory process? - ANSWER-defend against harm, rid the body of damaged tissue, and to promote restoration of normal tissue What are the 5 classical signs and symptoms of inflammation? - ANSWER-Pain, redness, swelling, heat/warmth, dysfunction Who administers the certification process for professionals in infection control and epidemiology? - ANSWER-The Certification Board of Infection Control and Epidemiology Who accredits the CBIC? - ANSWER-the National Commission on Certifying Agencies, a committee of the National Competency Assessment Organization What two regulatory bodies put forth standards of practice for infection control professionals? - ANSWER-The CDC and APIC (the Association of Professionals in Infection Control and Epidemiology) What are the stages of the inflammatory process? - ANSWER-Tissue injury, release of chemicals (from damaged cells to facilitate vasodilation and increased blood supply), migration of leukocytes (to the site of damage) What are the commonly used blood tests for infection? What are they sensitive to? - ANSWER-erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and plasma viscosity (PV); all are sensitive to increases in protein, which is a part of the inflammation process Describe Erythrocyte Sedimentation Rate (ESR). What is the normal range? What does a high ESR indicate? - ANSWER-measures the rate at which the red blood cells separate from the plasma and fall to the bottom of the test tube within a given period of time; normal ESR for females is 0-20 mL/hr, for males is 0-15 mL/hr; slightly higher among elderly; high rate indicates the presence of infection because the proteins of infection cover the RBCs thus causing them to fall more rapidly Describe C-reactive protein (CRP). What is the normal range? - ANSWER-can rise as high as 1000x above the normal rate when infection and inflammation occur; normal C-reactive protein is <1.0 mg/dL or <10 mg/L Describe plasma viscosity (PV). What is the normal range? - ANSWER-higher temperatures lead to lower viscosity, and lower temps lead to increased blood thickness and viscosity; normal viscosity of blood at 37 C is 3 x 10-3 to 4 x 10-3 What is a sensitivity test? - ANSWER-subjects a culture to a number of antibiotics What are the normal CSF values? - ANSWER-Pressure between 70-180 mm H2O, colorless and clear appearance, 15/60 mg/100 ml of total protein, 3-12% gamma globulin of the total protein, 50-80 mg/100 mL glucose, 0-5 mononuclear white blood cells, no red blood cells, 110-125 mEq/L chloride Define epidemiology. - ANSWER-the study of how health-related states are caused and distributed in specific populations What are the models of epidemiology? - ANSWER-The epidemiological triad, the wheel of causation, the web of causation, and the determinants of health model Describe the epidemiological triad model. - ANSWER-the agent, the host, and the environment. the three components are in a constant state of interaction with each other and with other factors like risk and the transmission of disease Describe the wheel of causation model. - ANSWER-takes focus away from the cause of disease, and places emphasis on genetics as well as biological, physical, and social environments as cause Describe the web of causation model. - ANSWER-further describes the relationships and interrelationships among multiple factors that impact health and disease than the other models Describe the determinants of health model. - ANSWER-recognizes that the intricate relationships among various and multiple factors impact on health and disease in a multidimensional manner What are the determinants of health? - ANSWER-Human biological determinants (e.g., nutritional status, genetic composition), Psychological determinants (e.g., stress, anxiety), Social determinants (e.g., cultural impacts, political structures), Economic determinants (e.g., income status), Environmental determinants (e.g., poor water quality), Health system determinants (e.g., access to healthcare), Behavioral determinants (e.g., lifestyle risk behaviors) What are the 5 factors in determining causal relationships? - ANSWER-Plausibility (makes sense biologically), strength of association, consistency (observed repeatedbl among different populationsand time), temporality (cause comes before the effect), biological gradient (dose-response relationship) What makes the best data measurement tools - ANSWER-having a high degree of validity and reliability Define validity. - ANSWER-the measurement tool's ability to actually measure what it's supposed to; also reflects sensitivity and specificity Define sensitivity. - ANSWER-how well the tool identifies the disease Define specificity. - ANSWER-how well the tool identifies those who do not have the disease Define reliability. - ANSWER-the measurement tool's ability to consistently measure the variable over time with the same results among different data collectors Define positive predictive value. - ANSWER-how well the tool is able to identify the number of people that have a positive test and also have the disease, AKA true positive Define negative predictive value. - ANSWER-how well the tool is able to identify the number of people that have a negative test and do not have the disease, AKA true negative How are microbials classified? - ANSWER-As microbicidal or microbiostatic, and according to the specific type of microorganisms Define microbicidals. - ANSWER-destroy microbes Define microbiostatic. - ANSWER-inhibit growth and reproduction What are the types of antimicrobials? - ANSWER-antibacterial (antibiotics), antifungal, antiviral, and antiparasite What are the different uses of antimicrobials? - ANSWER-Therapeutic (treatment based on microbial testing), prohylactic (prevention), empiric (treatment based on signs and symptoms) What is a primary prophylactic antimicrobial? - ANSWER-prevents infection What is a secondary prophylactic antimicrobial? - ANSWER-Treats and prevents recurrence of infection What is public health surveillance? - ANSWER-is the methodical, ongoing, and systematic collection, analysis, interpretation, and dissemination of data related to a public health concern A good surveillance system should include what? - ANSWER-Stakeholder involvement, a description of the surveillance system (including the purpose and operation of it), the dissemination of findings, privacy, surveillance resources (costs), systemic evaluation What is the name of the standardized classification of data coding, and who puts it out? - ANSWER-SNOMED (Systematized Nomenclature of Medicine), the College of American Pathologists What is quantitative research? - ANSWER-An empirical, systematic investigation of phenomena using statistical, mathematical techniques for data analysis What is the Likert scale? - ANSWER-how strongly someone agrees or disagrees with something (strongly agree, agree, neutral, disagree, strongly disagree) What is the Guttman scale? - ANSWER-data is collected along a continuum and then ranked based on least extreme opinion to most extreme. Time-consuming What are the 4 basic classifications of observation? - ANSWER-concealment with intervention, concealment without intervention, no concealment with intervention, and no concealment without intervention (concealment = whether the subject knows they're being observed, intervention = the observer acts in a way that leads to a change in the patient) What are the 3 measures of central tendency? When all 3 are the same, what is the distribution called? - ANSWER-mean, median, mode; normal What are the measurements of variation? - ANSWER-range, variance, standard deviation Define variance. - ANSWER-reflects how much the values vary around the mean. The average squared deviance of all values from the mean (S2) Define standard deviation. - ANSWER-shows how much variance there is around the mean. The square root of the variance Define inferential statistics. - ANSWER-infer conclusions about subjects of the study; allow researchers to make predictions about the larger population What is a correlation coefficient? - ANSWER-used to describe correlation; positive correlation is when independent and dependent variable both increase or decrease (ex: incidence of flu goes down when population decreases), negative correlation is when independent and dependent variables go in opposite directions (ex: operative infection rates decrease when surveillance increases) What is a Type I statistical error? - ANSWER-mistaken rejection of the null hypothesis (that the variables are unrelated); in other words, one concludes there is a relationship between two variables when there is no real connection What is a Type II statistical error? - ANSWER-mistaken acceptance of the null hypotheses; a false negative; when there is believed to be no relationship between two variables when there actually is one What is benchmarking? - ANSWER-finding out how a surveillance study's results compare to other studies' results What is internal benchmarking? - ANSWER-comparing two or more groups in the same organization (ex: IP comparing HAIs between units) What is external benchmarking? - ANSWER-comparing performance of one organization to two or more other organizations Who is NARMS? - ANSWER-the National Antimicrobial Resistance Monitoring System for Enteric Bacteria, survey and track all changes in antimicrobial susceptibility of certain enteric bacteria, food animals, and meat Define ratio. Give an example. - ANSWER-the mathematical relationship between two numbers. Ex: 1 HAI in every 1,000 inpatients What is an incidence rate? - ANSWER-the same as incidence but expressed by "per x # of people" (person-time); describes the rate at which something is happening moment to moment What is an incidence proportion? - ANSWER-same as incidence but expressed as a percentage; describes what happens over an accumulation of time What age range is described in the infant mortality rate? - ANSWER-less than 1 year of age What age range is described in the neonatal mortality rate? - ANSWER-less than 28 days old What age range is described in the post-neonatal mortality rate? - ANSWER-28 days to 1 year What is the proportionate mortality rate? - ANSWER-ratio between the number of deaths attributable to a specific cause over the total number of deaths What is the case fatality rate? - ANSWER-the number of deaths divided by the number affected by a specific disease What is morbidity rate? - ANSWER-the rates of illness, diseases, infections, disability, etc What is attach rate? - ANSWER-the proportion of people who have been exposed and got the disease out of total exposed Define risk stratification. - ANSWER-profile individuals, groups, and populations using several techniques such as threshold modeling, clinical review, and statistical modeling Define threshold modeling. - ANSWER-Risk stratification technique including certain individuals, groups, or populations based on the inclusion criteria, then assigning a particular healthcare intervention Define clinical reviews. - ANSWER-Risk stratification technique including certain individuals, groups, or populations, and then further exploring and examining them using a clinical review to reconfirm their inclusion specifics, and eligibility to get a particular healthcare intervention Define statistical modeling. - ANSWER-Risk stratification technique that uses the analysis of the individual, group, or population historical data to predict future occurrences and events for this individual, group, or population. How are quality indicators categorized? - ANSWER-Core measures or outcome measures What are core measures? - ANSWER-standardized measures of quality. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) uses ORYX National Hospital Quality Measures, which include measures of disease, population measures such as pediatric care, and organizational measures like those used in the emergency department What are outcome measures? - ANSWER-used to examine outcomes of care. Ex: mortality and morbidity rates, infection rates related to HAIs, length of stay, and readmissions What is root cause analysis? - ANSWER-the process used to dig down to the deepest, real reasons why mistakes and errors have occurred; Occurs in a blame-free environment with teams of stakeholders who closely analyze faulty processes What are sentinel events? - ANSWER-an occurrence that leads to, or has the potential to lead to, an adverse outcome; examined using root cause analysis What are the 4 types of variance (in the context of quality improvement)? - ANSWER-practitioner, system/institutional, community, and patient/family variance Define random variance. - ANSWER-one that occurs because of factors inherent to the process; occurs each time the established process is carried out Define specific variance. - ANSWER-occurs due to one faulty part of the process What must be true in order for change to occur? - ANSWER-the force of the facilitators to change must be greater in strength than the barriers to change Describe Lewin's Forced Field Theory of Change. - ANSWER-one of the most popular theories of change; consists of three phases of change: unfreezing (awareness that there is a problem, need, or opportunity that must be addressed with some action; is a challenge because many people resist change and prefer the status quo), freezing ( the planned change is implemented; those affected by the change may experience fear, uncertainty, and resistance), and refreezing (the affected people have fully accepted and implemented the change; it becomes somewhat routine) Describe Havelock's Six Phases of Planned Change. - ANSWER-the 6 phases are developing relationships, diagnosing the existing problem, collecting available resources, choosing a solution, garnering acceptance, and stabilizing the change Describe Lippitt, Watson, and Westley's Seven Phases of Change - ANSWER-patient awareness of the need for change, the development of a change agent/patient relationship, which includes the educator-patient relationship, the problem is defined, the goals are established, the plan for change is implemented, the change is accepted, and the change agent/patient relationship changes Describe Roger's Innovation Decision Process. - ANSWER-the infection control professional, as the change agent, provides others with knowledge and information about the benefits of change during the five stages: knowledge, persuasion, decision, implementation, and confirmation Describe chaos theory. - ANSWER-addresses the constantly changing environment and the way it affects the patient as an open system; always expect the unexpected What are the 5 unique decision-making processes? - ANSWER-Decide (the leader collects data and info from team members, but it is the leader that makes the final decision), an individual consultation (the leader talks to each group member alone and never consults with the group as a whole. The leader then makes a final decision), group consultation (the group and leader meat to share info and opinions about the problem. After the consultation, the leader makes a decision), facilitation (the leader collaborates with the group as a whole as they work towards a unified and consensual decision. The final decision is made by the group, not the leader), delegation (the leader takes a backseat approach, passing the problem over to the group. The group then comes to a decision without direct collaboration from the leader) Describe the common decision-making process. - ANSWER-Identifying the purpose of the decision-making, Establishing criteria, Ranking and weighing criteria, Exploring the alternatives in terms of the established criteria, Implementation of the selected course of action, Evaluating the outcome Describe the problem-solving process. - ANSWER-Problem definition (the most commonly occurring cause of problem-solving failures is a failure to clearly define the problem), data collection, data analysis , generating possible solutions, selecting the best possible solution, implementing the solution, evaluating the result of the solution Describe evidence-based practice. - ANSWER-begins with research, which is applied to the development and dissemination of evidence-based practice guidelines through publications and professional conferences Who makes recommendations on outbreak reporting? What are the recommended details to be reported? - ANSWER-the CDC and the National Outbreak Reporting System (NORS). The name of the reporting agency and date of report; outbreak demographics (number of cases, gender, and ages of those affected, and symptoms, severity, incubation period, and duration of the illness); the name of the causative agent/chemical/toxin; the exposure and transmission of the agent; the type of outbreak, setting, mode of transmission, and location or source of the outbreak; the methods and techniques used to identify, explore, and investigate the outbreak Define case definition. What system is it recommended cases are reported to? - ANSWER-a collection of uniform criteria used to define a disease that can be subjected to surveillance; updated on at least an annual basis; the Council of State and Territorial Epidemiologists (CSTE) recommends that state health departments report cases of disease to CDC's National Modifiable Diseases Surveillance System (NNDSS) How are case definitions classified? - ANSWER-Confirmed case, epidemiologically-linked case (a case where a person had contact with a confirmed case), clinically compatible case, laboratory confirmed case (case confirmed by a lab method listed in the definition of the specific case in the Laboratory Criteria for Diagnosis), probable case, supportive or presumptive laboratory results (results used for or consistent with the diagnosis but not included in the Laboratory Criteria for Diagnosis for the specific disease), suspect case What are the actions infection control providers implement when there has been an infection control breach? - ANSWER-The identification of the breach, the collection of additional data and information, the notification of stakeholders, the qualitative determination of risk (either category A or B), and patient notification What is a category A infection control breach? - ANSWER-breaches that result from gross error or a high-risk practice that has a high chance of exposure affecting others (ex: reuse of syringes) What is a category B infection control breach? - ANSWER-breaches defined as less severe than A where there is a lower possibility of exposure (ex: incorrect endoscopic equipment disinfection by incorrect solution or insufficient period of time) What is an autoclave? - ANSWER-sterilizing device using steam under pressure What is a bactericide? - ANSWER-an agent that kills bacteria What is biofilm? - ANSWER-the accumulated mass of bacteria and extracellular material that is tightly adhered to a surface and cannot be easily removed What is contact time? - ANSWER-the time a disinfectant is in direct contact with the surface or item to be disinfected What is a control, positive? - ANSWER-a biologic indicator from the same lot as a test biologic indicator that is left unexposed to the sterilization cycle and then incubated to verify the viability of the test biologic indicator What is detergent? - ANSWER-a cleaning agent that makes no antimicrobial claims on the label; they're comprised of a hydrophilic component, and can be divided into 4 types: anionic, cationic, amphoteric, and non-ionic Define D value. - ANSWER-the time or radiation dose required to deactivate 90% of a population of the test microorganism under stated exposure conditions What is flash sterilization? - ANSWER-the process designed for the steam sterilization of unwrapped patient care items for immediate use What is general disinfection? What has it been demonstrated to kill? - ANSWER-an EPA-registered disinfectant labeled for use against both gram-negative and gram-positive bacteria; also called broad spectrum disinfectant; demonstrated to kill salmonella and staphylococcus What is a germicidal detergent? - ANSWER-a detergent that is also an EPA-registered disinfectant What is inorganic and organic load? - ANSWER-naturally occurring or artificially placed inorganic (ex: metal salts) or organic (ex: proteins) contaminants on a medical device before exposure to a microbicidal process What is limited disinfectant? - ANSWER-registered for use against a specific major group of organisms (ex: gram-negative bacteria) What is a lipid virus? - ANSWER-a virus surrounded by an envelope of lipoprotein, surrounded by a coat of protein. This type of virus (ex: HIV) is typically easy to inactivate Define the minimum effective concentration (MEC). - ANSWER-a virus surrounded by an envelope of lipoprotein, surrounded by a coat of protein. This type of virus (ex: HIV) is typically easy to inactivate What is a non-lipid virus? - ANSWER-generally more resistant to inactivation than lipid viruses Define parametric release. - ANSWER-the declaration that a product is sterile on the basis of physical and/or chemical process data (rather than sample testing or biologic indicator results) What is sanitizer? - ANSWER-an agent that reduces the number of bacterial contaminants to safe levels; according to the protocol for the official sanitizer is a chemical that kills 99.999% of the specific test bacteria in 30 seconds under the conditions of the test What is a spore? - ANSWER-a water-poor round or elliptical resting cell consisting of condensed cytoplasm and a nucleus, surrounded by an impervious cell wall or coat Define steam quality. - ANSWER-a steam characteristic reflecting the dryness fraction and the level of non-condensable gas; the dryness fraction should not fall below 97% Describe the dynamic air removal tpe of steam sterilization. - ANSWER-one of two types of sterilization cycles in which air is removed from the chamber, and the load is inactivated by a series of pressure and vacuum excursions, or by a series of steam flushes and pressure pulses above atmospheric pressure What methods are used to test the efficacy of dinsinfectants? - ANSWER-Rideal Walker method, Chick Martin test, Koch's method, capacity use dilution test, in-use test How should sterile supplies be stored? - ANSWER-at least 10 inches from the floor, 2 inches from the wall, and 18 inches from the ceiling so that supplies can have adequate ventilation What does a positive indicator test mean? - ANSWER-A single positive test does not necessarily indicate sterilization failure, but the sterilizer must be immediately rechallenged Give examples of sterilizing agents. - ANSWER-Peracetic acid, ionizing radiation, dry heat sterilization, liquid chemicals, vaporized hydrogen peroxide, ozone, gaseous chlorine oxide, heat, autoclave sterilization Describe peracetic acid as a sterilizing agent. - ANSWER-an oxidizing agent that removes surface contaminants; oxidizes sulfhydryl and sulfur bonds in proteins, enzymes, and other metabolites, and it stops cell wall permeability Describe ionizing radiation as a sterilizing agent. - ANSWER-a low temperature sterilization technique that employs electron accelerators or cobalt 60 gamma rays; rarely used because expensive and no FDA-cleared processes for healthcare facilities; often called "cold sterilization" Describe dry heat sterilization. What are the two types? - ANSWER-used only when the equipment can become damaged and unusable when it is subject to moist heat (ex: sharp instruments can become dull with moist heat); the two types of dry heat sterilizers are forced air type and static air type When are liquid chemicals indicated as sterilizing agents? - ANSWER-restricted to items that are heat sensitive Describe vaporized hydrogen peroxide as a sterilizing agent. What is it effective against? - ANSWER-uses relatively rapid vacuum systems; accommodates most materials and is simple to use; effective against MRSA, C. diff, serratia marcescens, and clostridium botulinum Describe ozone as a sterilizing agent. - ANSWER-an oxidant created by the sterilizing machine with self-contained biological and chemical indicators; after the process is completed, the ozone converts back to water vapor and oxygen; can be used for a wide variety of materials and is effective against very resistant microorganisms Describe gaseous chlorine oxide as a sterilizing agent. - ANSWER-rapid, usually only takes 30 minutes; no mutagen or carcinogen effects on humans Describe heat as a sterilizing agent. - ANSWER-perhaps the most reliable form of sterilization; heat coagulates proteins and has an oxidative effect; dry heat is less effective than moist heat; as temp increases, time for sterilization decreases Describe autocloave sterilization. - ANSWER-commonly used in healthcare; uses a combination of heat and pressure; many items can be sterilized in less than 15 minutes What are some procedures that pose a risk for infection? - ANSWER-Dialysis, endoscopy, bronchoscopy, urinary drainage catheter, intravascular devices What are the most commonly occuring infections associated with endoscopy? - ANSWER-blood-borne pathogens like Hep B and C What are the most commonly occuring infections associated with bronchoscopy? - ANSWER-Pseudomonas aeruginosa, Serratia marcescens, NTM, and fungi What are some alternatives to using indwelling urinary catheters? - ANSWER-portable ultrasound devices to assess urine volume and antimicrobial-impregnation catheters (ex: silver-alloy coated catheters); external condom catheters should be considered for male patients What are Class I recalls? - ANSWER-involves products that have a reasonable probability that their use would cause serious adverse health consequences or death What are Class II recalls? - ANSWER-involves products that may cause temporary or reversible adverse health consequences, or where the probability of serious adverse health consequences is not probable and remote What are Class III recalls? - ANSWER-involves products not likely to cause adverse health consequences What are the most common risk factors for healthcare infections? - ANSWER-prolonged illness and immunosuppression (ex: HIV, chemotherapy) What are the most common sites of HAIs? - ANSWER-The urinary tract, respiratory tract, wounds, and bloodstream What is the single most effective way to prevent HAIs? - ANSWER-handwashing Describe a category A bioterrorism agent. Give examples. - ANSWER-most lethal; easily and quickly spread to others with human contact. Tuleremia, anthrax, smallpox, botulism, viral hemmorhagic fever (caused by pathogens from the Filoviriday and Arenaviridae families, like Ebola), Bubonic plague Describe a category B bioterrorism agent. Give examples. - ANSWER-second most lethal; spread quickly and cause high morbidity and mortality rates. Salmonella (non-typhoidal and typhoidal), shigella, brucellosis, Q fever, psittacosis, Ricin, Staphylococcus enterotoxin B , typhus, viral encephalitis (caused by a variety of viruses like measles, herpes simplex, mumps, rabies, West Nile, rubella) Describe a category C bioterrorism agent. Give examples. - ANSWER-although a threat to public health, these agents are less lethal and threatening; this category includes new and emerging threats that can easily be produced and released in the future; examples: hantavirus, Nipah virus, SARS, H1N1 What immunizations are required for healthcare personnel? - ANSWER-hepatitis B, MMR, and annual influenza What organization provides guidance on record keeping? - ANSWER-CDC What does OSHA mandate in regards to record keeping? - ANSWER-their confidentiality, employees' rights to access them, their retention for at least 30 years after employment has ceased, and complete, accurate, and current record keeping What are the 8 characteristics of successful leaders according to Stephen R Covey? - ANSWER-Are service-oriented, Are synergistic thinkers who view the whole as greater than the sum of its parts, Seek out and actively engage in lifelong learning, Believe in other people, Transmit positive energy that motivates others, Are committed to the common good, View life as a challenging adventure and they lead a balanced life, Actively engage in their own self renewal How are the 3 major theories of leadership classified? - ANSWER-situational, attitudinal, and trait Describe situational theories of leadership. - ANSWER-leaders respond with certain behaviors according to the situation Describe attitudinal theories of leadership. - ANSWER-leaders respond and act according to their attitudes rather than the situation Describe trait theories of leadership. - ANSWER-leaders, their attributes, and traits define the leader and their actions, rather than other factors or forces that inspire others Describe transformational leadership theories. - ANSWER-AKA relationship theories; focus upon the connections formed between leaders and followers; considered to be one of the best forms of leadership; transformational leaders motivate and inspire others with a shared vision, have high expectations of others and themselves, and are adept at setting clear goals to managing conflicts Describe the learning organization theory. What are the 5 components of it? - ANSWER-the leader is a visionary who aims to create a learning organization with a shared vision; these organizations continuously evolve and transform because constant learning occurs among all members of the group. Systems thinking (organizations are open, interconnected systems; changing a part changes the entire system and the environment), personal mastery (all members are committed to learning), mental models (ex: collective memories and cultural norms; learning organizations challenge mental models, discard them, and form new ones that are consistent with the organization), shared vision (offers organizations a common identity, and for a learning organization, that vision is continuous learning), team learning (the sum of individual learning; occurs when members cross boundaries, such as departmental boundaries, in an atmosphere that facilitates and motivates members to open dialogue). Describe Likert's Leadership Styles Theory. What are the 4 types of leaders it describes? - ANSWER-the idea that if leaders build affinity with their followers or subordinates, they will be more able to create and maintain a work environment that is effective, productive, and capable of goal achievement; the types of leaders are: exploitatative-authoritative (leaders motivate others with punishments, fears, and threats; leader makes all the decisions and is usually unaware of problems that exist on the front line), benevolent-authoritative (less punishment and more rewards; also includes more participation of staff at the lowest levels and therefore more awareness of their problems; decisions are still made by the leader, communication moves from the top to the bottom, and little communication goes upwards), consultative (facilitates higher levels of motivation, increased job satisfaction, and greater productivity than the first two types; punishments decrease, rewards increase, communication moves freely both downward and upward, and workers have more of a role in problem solving and decision making), participative (most effective and satisfying because there is full participation in decision making and a reward system in place) What are the 3 primary leadership stypes of Lewin's leadership theory? - ANSWER-Autocratic leadership (these leaders make independent decisions without communicating, collaborating, or consulting others; this style is indicated in emergency situations, but in other situations it causes workers to be unmotivated, uncreative, and lacking a sense of ownership), democratic leadership (leaders provide guidance to members and get work input in the decision-making process; highly effective and beneficial), laissez-faire leadership (these leaders give team members a great amount of freedom and autonomy, but are readily available to provide necessary resources, including guidance and support; high satisfaction and increased productivity) Describe the Goleman, Boyatzis, and McKee 6 leadership styles. - ANSWER-Visionary (the leader articulates goals but not the process to reach them), coaching (the leader's coaching maximizes the connection of the individual's personal and job-related goals to the person's unique strengths), affiliative (the leader demonstrates genuine empathy to create harmonious relationships within the group), democratic (the leader collaborates with members of the team, and they collectively and collaboratively resolve conflicts), pacesetting (the leader increases levels of performance and influences others to work more effectively), commanding (least effectively; leader mandates compliance without expectations, controls and monitors group closely) Describe the leadership style matrix. How is it categorized? - ANSWER-leaders should select the best style to use after considering the group members, their level of competency, and the nature of the situation. Work-related and group member needs. What are the components of the communication process? - ANSWER-sender (transmits messages), receiver, message, channel (the means the message is conveyed), feedback or repsonse (verbal and non-verbal from the receiver to the sender after a message), variables, encoding (the cognitive process that the sender uses when contemplating how they will frame or formulate the message), decoding (the cognitive process the receiver uses to comprehend the message that is received from the sender) Describe the personal spaces. - ANSWER-the intimate zone (between 6 inches and 1.5 feet from the body, entered by those with an intimate relationship or by healthcare personnel for a procedure requiring it), personal zone (1.5 feet to 4 feet from the body, entered in social gatherings), social zone (4 feet to 12 feet, interactions with strangers), public zone (over 12 feet, addressing or speaking to an audience) What is the SMARTTA framework, and what is it used for? - ANSWER-S - specific, M - measurable, A - achievable, R - realistic, T - timeframe, T - trackable, A - agreed to by the patient and significant others. Used for setting goals. What are the 3 domains of learning? - ANSWER-The cognitive, psychomotor, and affective domains. Describe the congitive domain. - ANSWER-consists of both knowledge and understanding. Ex: the patient verbalized knowledge of all of their medications and side effects"; some teaching/learning strategies include computer based learning, peer group Describe the psychomotor domain. - ANSWER-"hands-on" skills like taking blood pressure and using blood glucose monitor correctly; some teaching/learning strategies of this domain include demonstration, return demonstration, and a video with a demonstration Describe the affective domain. - ANSWER-the development of attitudes, beliefs, values, and opinions. Ex: developing a belief that exercise is a valuable part of wellness; teaching/learning strategies include role-playing and values clarification exercises (this domain is rarely used for patient teaching)