CIC Studying 2024: CIC Practice Exam Questions

CIC Studying 2024: CIC Practice Exam Questions Recipients of allogenic hematopoeietic stem transplantation (HSCT) should be placed in rooms with how many air exchanges per hour? 3 5 10 12 - ANS 12. A greater number of air exchanges per hour prevent opportunistic infections among stem cell transplant recipients Because of the increased risk of infection with parenteral nutrition, the maximum infusion time for a parenteral lipid bag to run is? 6 hours 12 hours 18 hours 24 hours - ANS Maximum 12 hours. Lipid emulsions pose greatest risk of contamination w/ bacteria or fungi The single most effective method of controlling hospital-acquired infections (HAI) is: Screening patients Isolating infected patients Handwashing Immunizing staff members - ANS Handwashing If a breastfeeding mother develops mastitis, the most likely cause is: Infant colonized with Staphylococcus aureus Inadequate cleansing of breast Maternal flora invading nipple Contaminated breast pump - ANS Infant colonized with S. aureus. 50% of neonates become colonized w/ S. aureus w/in a few days of birth, & pass infection into breast If hair removal is required for a surgical procedure, the BEST method is to: Shave hair with razor immediately before the incision Remove hair with a depilatory the night before surgery Remove hair with clippers the night before surgery Remove hair with clippers immediately before incision - ANS Remove hair with clippers immediately before incision. Clippers cause the least trauma, always immediately before surgery. Hair removal in general may not reduce rate of SSIs and may increase risk of infection IPC plan for an ambulatory surgery center should be evaluated (multiple options possible): I - annually II - monthly III - when risks change IV - when staff members change - ANS I - annually and III - when risks change How long after exposure to Hep A are IgM antibodies to HAV detectable in the blood? 48 hrs 7 days 3 weeks 1-10 weeks - ANS 3 weeks For patients who require hemodialysis, which type of vascular access device (VAD) poses the lowest risk of infection? Arteriovenous graft Subclavian catheter Arteriovenous fistula Right internal jugular catheter - ANS Arteriovenous fistula. Placed in the arm rather the thigh. Patients w/ catheters have 7x the risk of infection (subclavian catheters have high risk). Patients w/ chronic kidney disease should have vascular access preserved and AV fistulas created as soon as possible Which items in medical facility require most frequent environmental cleaning?: Bedrails Floors Ventilation grilles Window curtains - ANS Bedrails, because they are high touch. Others only require frequent cleaning if visibly soiled Which preventive measures are recommended to prevent community-acquired pneumonia?: Pneumococcal vaccination Herpes zoster vaccination Influenza vaccination Smoking cessation - ANS Pneumococcal vaccine, influenza vaccine, smoking cessation The best time to collect a sputum specimen for acid-fast bacilli is: Early morning Midday Afternoon Bedtime - ANS Early morning A distribution curve that has a skew value of +3 will exhibit what shape? - ANS An enlarged tail to the right. This is indicating there are more data than expected on the right (or positive) end of the distribution curve. Skew is positive when the mean is greater than the median, negative when the mean is lesser than the median. Value of 0 = normal bell curve with no skew. Negative value = skew to the left. How long does a patient remain infectious after exposure to West Nile virus? - ANS 6-7 days before symptoms occur With which teaching style (Grasha) does the IP focus on content rather than relationships w/ learners?: Demonstrator Formal authority Facilitator Expert - ANS Formal authority In outbreak investigation, a line list & epi curve have been completed. Before generating hypotheses, the next step should be to: Establish plan for methodology Conduct lit review Conduct brainstorming session Determine what resources are needed - ANS Conduct lit review to ID other outbreaks w/ similar profiles Which diagnostic tests for C. difficile has the BEST sensitivity and specificity?: Nucleic acid amplification (ex. PCR) Glutamate dehydrogenase Toxigenic culture Toxic enzyme immunoassay (EIA) - ANS NAAT, including PCR, has excellent sensitivity/specificity, is quick, but is expensive When considering reprocessing medical devices, most facilities will require: A contract w/ third party reprocessing organization Increasing training for staff regarding reprocessing procedure Hiring of additional personnel Improved sterilization, processing equipment - ANS A contract w/ third party reprocessing organization Burn patients are especially at risk due to: Overall immunosuppresion Loss of skin barrier Use of invasive devices Microorganisms's development of resistance to topical abx - ANS All of the above Which agency regulates medical waste and incinerators? - ANS EPA Most common cause of early-onset neonatal meningitis is maternal transmission of: Neisseria gonorrhoeae Group B streptococcus Cytomegalovirus Toxoplasma gondii - ANS Group B strep Epi curve that rises slowly and then plateaus most likely represents: Common continuous exposure Common intermittent exposure Prpagated source Point source - ANS Common continuous exposure If a mother is pumping breast milk, what is the optimal time that milk should be stored in fridge at 4 degrees C? - ANS 72 hours Which indicator is likely to require longest time period for collection of surveillance data?: CLABSI CAUTI CDI VRSA - ANS VRSA. Infection is rare, so likely to require longest time to determine rates of infection, usual rates of occurrence, etc Purpose of the just-in-time inventory concept is to: Minimize costs of inventory Maintain better control of inventory Prevent waste of medical supplies Ensure adequate stock of medical supplies - ANS Minimize costs of inventory Steps to reduce peritoneal dialysis catheter-associated infections include: I - Placing exist site of catheter at beltline II - Using double-cuff catheter III - Using strict aseptic technique IV - Avoiding baths/showers until insertion site heals - ANS II - Using double-cuff catheter III - Using strict aseptic technique IV - Avoiding baths/showers until insertion site heals What clinical manifestation in a pediatric patient should give an IP a high index of suspicion for chicken pox?: A. Lesions first appear on the face or trunk B. Lesions first appear in the throat or mouth C. Bright red rash that appears on the cheeks D. Inflamed, red or peeling skin on knees and elbows - ANS Lesions first appear on the face or trunk Select ALL the conditions that warrant airborne precautions: A. Norovirus B. Hepatitis A C. Measles D. Varicella E. Disseminated Varicella Zoster F. Tuberculosis G. Whooping Cough H. RSV I. Epiglottitis - ANS Measles, disseminated varicella zoster, tuberculosis Koplik spots are a symptom that is specific to which of the following viruses: a. Varicella b. Rubella c. Rubeola (10 day measles) d. Coxsackievirus - ANS Rubeola (measles) Anti-HBc indicates: a. Prior infection with Hepatitis B. b. Status as a Hepatitis B carrier. c. New infection with Hepatitis B. d. Prior immunization with Hepatitis B vaccine. - ANS a) Prior infection with Hepatitis B Serologic markers of a recent infection include: a. IgG b. IgM c. IgA d. IgC - ANS b) IgM A gram stain of cerebrospinal fluid showing gram negative diplococci strongly suggest which of the following: a. Aseptic Meningitis b. Pneumococcal disease c. Meningococcal disease d. H. influenzae disease - ANS c) Meningococcal disease The first step in an outbreak investigation is: a. Develop a case definition. b. Begin case finding. c. Confirm the outbreak. d. Notify senior leadership. - ANS c. Confirm the outbreak Surveillance is defined as: a. Systematic collection of data for reporting. b. Focused data collection to detect problems. c. Targeted collection of data for quality assurance. d. Systematic collection of data for planning, implementation, and evaluation. - ANS d. Systematic collection of data for planning, implementation, and evaluation Endemic infections are those infections that occur in a population: a. Rarely. b. at a usual rate. c. at a higher-than-normal rate. d. that has never been affected by them before. - ANS b. at a usual rate. Pandemic infections are those that occur: a. In a narrow geographic area. b. In a single country affecting many people. c. Among a previously unaffected population. d. In a widespread geographic area affecting much of the population. - ANS d. In a widespread geographic area affecting much of the population. Virulence describes: a. The reservoir of an organism. b. A factor related to a disease host. c. The ability of an organism to invade a host and cause disease. d. The ease with which an organism can be killed/inactivated by disinfectants. - ANS c. The ability of an organism to invade a host and cause disease. The Advisory Committee on Immunization Practices (ACIP) recommends which of the following vaccines for all persons over the age 65?: a. MMR b. TDaP c. Varicella d. Pneumococcal - ANS d. Pneumococcal Important interventions to prevent central line-associated bloodstream infections include: a. Ensuring that central lines are rotated periodically. b. Ensuring all central lines are inserted in a procedure room. c. Ensuring that skin is cleansed with iodophor prior to insertion. d. Evaluating products to ensure all needed supplies are contained within insertion kits. - ANS d. Evaluating products to ensure all needed supplies are contained within insertion kits Important interventions to prevent catheter-associated urinary tract infections include: a. Regularly changing urine collection bags. b. Obtaining a urine culture when a foul odor is present. c. Obtaining a urine culture urine when pyuria is noted. d. Ensuring urinary catheters are inserted for appropriate indications. - ANS d. Ensuring urinary catheters are inserted for appropriate indications. Elements of an Occupational Health program include: a. Surveillance of patient illnesses. b. Education of personnel about their risk of disease acquisition. c. Investigation of patients exposed to ill healthcare personnel. d. Notification of patients exposed to ill healthcare personnel. - ANS b. Education of personnel about their risk of disease acquisition A pregnant healthcare worker with previous history of varicella vaccination is assigned to care for an individual with disseminated shingles. She should: a. be reassigned to care for other patients. b. utilize Standard/Routine and Airborne Precautions while caring for the patient. c. receive an additional varicella vaccine during pregnancy. d. be advised to consult with her provider about potential exposure. - ANS b. utilize Standard/Routine and Airborne Precautions while caring for the patient. Competence may be thought of as: a. the process of teaching a skill to a learner. b. the ability to put knowledge into action. c. the process of attaining knowledge and skill. d. the ability to identify problems in the workplace. - ANS b. the ability to put knowledge into action According to the APIC Competency Model the Early Novice IP is should pursue competency in all the following except: a. Developing policies. b. Learning the basics of epidemiology. c. Performing advanced analysis of statistics. d. Participating in ongoing learning opportunities. - ANS c. Performing advanced analysis of statistics The most basic goal of infection prevention education is: a. Ensuring knowledge of policies and procedures. b. Identifying risk for disease transmission. c. Developing competency in infection prevention. d. Developing evidence-based procedures. - ANS c. Developing competency in infection prevention. A competency statement describes: a. Responsible personnel. b. Steps in a psychomotor skill. c. Recommended performance measures. d. Worker skill, knowledge, and mind set needed to perform a duty. - ANS d. Worker skill, knowledge, and mind set needed to perform a duty Infection preventionists should review which of the following when assessing the environment of care? a. Outdoor air quality. b. Weather related outdoor humidity. c. Air pressure relationships within the facility d. Elevation of the head of the bed for patients on ventilators. - ANS c. Air pressure relationships within the facility The temperature of cold food storage (e.g., refrigerators) is monitored and recorded every 4 hours. When reviewing the temperature log the IP notes that the refrigerator temperature has been recorded as being 45 degrees Fahrenheit for the previous 16 hours. What action should be taken first? a. No action is needed. b. A work order to fix the refrigerator should be placed. c. Discard food that has not been maintained at proper temperatures. d. Determine if the temperature is being recorded after the refrigerator doors have been open for restocking. - ANS c. Discard food that has not been maintained at proper temperatures Critical items, according to the Spaulding Classification, are those that: a. Contact mucous membranes. b. Contact normally sterile body sites. c. Must be high-level disinfected. d. Include surfaces in critical care units and surgery. - ANS b. Contact normally sterile body sites. Cleaning is defined as: a. Removal of organic material. b. Applying sporicidal solutions to surfaces. c. Inactivation and killing of microorganisms. d. Activities that achieve the absence of pathogenic levels of microorganisms. - ANS a. Removal of organic material A Gram stain indicates a Gram negative bacilli. What organism does it most likely represent? Staphylococcus aureus Enterococcus faecium Pseudomonas aeruginosa Clostridium perfringens - ANS c) Pseudomonas is the only Gram negative organism on the list. S. aureus are Gram positive cocci; E. faecium are Gram positive cocci; C. perfringens are Gram positive rods A child presents to the ER with fever, headache, and sudden bright red "slapped cheek" rash. Which virus is the likely cause? Coxsackievirus Human metapneumovirus Paramyxovirus Parvovirus B19 - ANS d) Parvovirus B19, which can cause a bright red facial rash in children referred to as a "slapped cheek" rash or Fifth Disease. **A good resource is the Red Book for pediatric infectious diseases** What is the specimen of choice for viral isolation from a patient with suspected mumps? Buccal swab Blood culture Skin scraping Stool - ANS a) Buccal swab, and you would need to perform a PCR test on it There has been an increased number of positive surgical site cultures from patients who don't have clinical infections. You suspect the specimens are being improperly collected. What is the most way to collect a wound culture? A - From drainage after cleaning the wound surface B - From the purulent material on the wound dressing C - From the wound prior to cleaning D - From the skin surface surrounding the wound - ANS A - From drainage after cleaning the wound surface b) is incorrect because it's not sterile c) is incorrect because you need to collect drainage expressed from the wound after cleaning d) is incorrect because of contamination from normal skin flora At what point(s) in the cycle of disease transmission can we as infection preventionists break the chain of infection, and how can we interfere at each point? Susceptible host Infectious microbe Reservoir Portal of exit Mode of transmission Portal of entry - ANS D, E, and F - these are the points where we can interfere D: prevent/cover coughing, sneezing, bleeding, feces E: By using contact/airborne/droplet precautions, preventing transmission to vehicle/insect vector F: Protect wound opening/mucus membrane via sterilization/disinfection of devices Match the following bacteria to a the body site where they are typically found (not causing disease): a) Streptococcus - ANS Nasopharynx Match the following bacteria to a the body site where they are typically found (not causing disease): b) N. meningiditis - ANS Nasopharynx Match the following bacteria to a the body site where they are typically found (not causing disease): c) S. epidermiditis - ANS Skin Match the following bacteria to a the body site where they are typically found (not causing disease): d) Lactobacillus - ANS Urogenital tract Match the following bacteria to a the body site where they are typically found (not causing disease): e) Streptococcus mutans - ANS Mouth Match the following bacteria to a the body site where they are typically found (not causing disease): f) Anaerobes - ANS Gut Match the following bacteria to a the body site where they are typically found (not causing disease): g) E. coli - ANS Gut Normal skin flora includes: Coagulase negative staphylococcus Coagulase negative streptococcus Coagulase positive staphylococcus Coagulase positive streptococcus - ANS a) Coagulase negative staphylococcus, such as S. epidermiditis, is normal skin flora Intact skin is not a barrier against infection from which of the following: Streptococcus Cryptococcus Staphylococcus HPV/Herpes simplex - ANS HPV/Herpes simplex Results compatible with meningococcal meningitis include: Gram negative cocci in pairs, WBC count 100, glucose 25 mg/100 mL Gram positive cocci in pairs, WBC count 100, glucose 25 mg/100 mL Gram negative in clusters, WBC count 100, glucose 80 mg/100 mL Gram negative cocci in clusters, WBC count 100, glucose 80 mg/100 mL - ANS a) Bacterial meningitis is usually caused by N. meningitidis (Gram (-) pairs). Bacteria in CSF eat glucose (making glucose low) and secrete protein. WBC and neutrophil predominant (for viruses, leukocyte predominant, glucose/protein won't be altered) What type of isolation precautions will be required for a patient with meningococcal meningitis.: Standard only Contact precautions Droplet precautions Airborne precautions - ANS c) Droplet precautions for bacterial meningitis What type of isolation precautions will be required for a patient with viral meningitis.: Standard only Contact precautions Droplet precautions Airborne precautions - ANS a) standard precautions The patient's cerebrospinal fluid (CSF) results are positive for Gram negative diplococci. Which of the following organisms could be causing the infection (multiple possible)? Moraxella catarrhalis Streptococcus pneumoniae Enterococcus faecalis Neisseria meningiditis - ANS A and D are both Gram negative diplococci Transmission of West Nile Virus via mosquitos is what type of transmission? - ANS Vector-borne A patient presents to the ER with genital pain and a history of unprotected sex. The clinician wants to rule out Trichomonas. What type of test should be ordered? - ANS Wet mount test Haomophilus influenzae is considered a commensal organism in which body site? Large intestine Nasopharynx Genitourinary tract Skin - ANS Nasopharynx A patient with disseminated herpes zoster requires a tracheostomy suction. What PPE is required for the healthcare workers administering the procedure? - ANS Disseminated herpes zoster requires airborne and contact precautions, so HCWs need to use an N95, face shield, gown, and gloves What transmission precautions should be followed when treating an unvaccinated three-year-old patient with varicella? - ANS Airborne, contact, and standard What type of transmission precautions should an incontinent patient with Hepatitis A be placed under? - ANS Contact precautions What type of transmission precautions should a continent Hepatitis A patient be placed under? - ANS Standard precautions Patient presents with cramps, vomiting, diarrhea, fever, chills that began 3 days ago. What is the most likely causative organism? - ANS Salmonella Patient with active pulmonary tuberculosis is hospitalized. What is the best predictor of contagiousness? - ANS Positive AFB smear. This means it is in the upper respiratory passage and could be transmitted An infection preventionist (IP) was notified that two patients developed post-procedure febrile reactions following a cardiac catheterization. This occurrence was MOST likely related to A) pyrogenic endotoxins present in reusable catheters following sterilization. B) inappropriate use of prophylactic antibiotics. C) scrubbed personnel who leave and reenter the procedure area without changing scrubs. D) scrubbed personnel adjusting the overhead lights during the procedure. - ANS A - pyrogenic endotoxins cause fevers. Endotoxins are the most ubiquitous pyrogenic contaminants for medical devices or products Identify the following as process measures or outcome measures: SSI rates Surgical care improvement project compliance Hand hygiene compliance MRSA colonization (HAI) - ANS A - Outcome measure B - Process measure C - Process measure D - Outcome measure True or false: Sentinel events are urgent and significant - ANS True True or false: Sentinel events require immediate investigation and response - ANS True The IP team and nursing education team collaborate on educational programs, giving the IP team the opportunity to develop skills labs. What teaching do skills labs provide? Cognitive Affective Psychomotor Reasoning - ANS Psychomotor The IP wants to increase awareness of infection prevention best practices with central lines. What is the best method to teach this? - ANS Simulation A critical review of methods should include all of the following except: Time period Controls compatible to cases Limitations/weaknesses Study design designed in detail - ANS Limitations/weaknesses A new infection preventionist (IP) is preparing a report and wants to describe the data. The simplest and crudest levels of measurements should include which of the following? A) rates B) risk ratios C) nominal scales D) measures of association - ANS C) nominal scales After collecting 6 months of prospective data on healthcare providers' reasons for failing to clean their hands, the team wants to evaluate both the barriers to hand hygiene as well as the most productive way to spend the limited resources provided to improve hand-hygiene practices. The best tool to use is a A) Pareto chart. B) fishbone chart. C) flow chart. D) control chart - ANS A) Pareto chart A Pareto chart is a bar graph. The lengths of the bars represent frequency or cost (time or money), and are arranged with longest bars on the left and the shortest to the right. In this way the chart visually depicts which situations are more significant. A student demonstrates appropriate tracheostomy suctioning technique to an instructor. This is an example of: a. cognitive learning. b. psychomotor learning. c. affective learning. d. theoretical learning. - ANS b. psychomotor learning An employee is exposed to blood and body fluids from a patient whose baseline testing revealed positive results in a rapid HIV test. The most appropriate follow-up test for the patient would be: a. Western Blot (HIV) b. Viral Load c. HIV polymerase chain reaction d. CD4 - ANS A. Western blot Rationale: Rapid HIV tests can offer a result in 15 minutes. A negative rapid test is reported as a definitive negative HIV test. Which of the following is the correct order for disinfecting endoscopes? a. High-level disinfection, rinse the scope with sterile water, flush the channels with 70 to 90 percent alcohol, dry using forced air b. Rinse the scope using sterile water, high-level disinfection, flush the channels with 70 to 90 percent alcohol, dry using forced air c. Flush the channels with 70 to 90 percent alcohol, rinse the scope using sterile water, high-level disinfection, dry using forced air d. Dry using forced air, high-level disinfection, flush the channels with 70 to 90 percent alcohol, rinse the scope using sterile water - ANS A. High-level disinfection, rinse the scope with sterile water, flush the channels with 70 to 90 percent alcohol, dry using forced air What is the first action HCP should take after a needlestick exposure? a. Contact the supervisor b. Contact Occupational Health c. Squeeze or milk the site d. Wash the affected area - ANS d. Wash the affected area A patient is admitted to rule out TB. All of the following would be noted as a risk factor for transmission of infection to the staff except: a. Improper N95 respirator use by the staff b. Surgical mask placed on the patient during transport c. Acid-fast bacilli (AFB) smear positive sputum culture from the patient d. Patient placed in a regular exam room in the emergency room - ANS b. Surgical mask placed on the patient during transport A patient is admitted to the hospital with severe community acquired pneumonia (CAP). His symptoms include hemoptysis and a multilobar infiltrate seen on chest radiograph. The patient is recovering from a recent influenza virus infection. What organism should be suspected? a. Moraxella catarrhalis b. Streptococcus pneumoniae c. MRSA d.Haemophilus influenzae - ANS C. MRSA Rationale: Community-associated MRSA (CA-MRSA) strains are primarily associated with skin and soft tissue infections; however, they are increasingly causing more invasive infections, including severe CAP. CA-MRSA should be suspected in patients with severe CAP plus hemoptysis, multilobar or cavitary infiltrate seen on chest radiograph, or neutropenia. There is a shortage of influenza vaccine, and the IP has been asked to help prioritize the administration of the vaccine among HCP in the facility. Which of the following employee groups would be among the highest priority for immunization? a. The admissions clerk in the ED b. The Lung Transplant Coordinator c. A nurse in labor and delivery d. The CEO of the hospital - ANS B. The Lung Transplant Coordinator Rationale: Of all HCP listed, this employee would get priority because they work postoperatively with immunocompromised patients who are at high risk for influenza infection. Any HCP who work with high-risk patients should be vaccinated against influenza. Phlebotomists within an organization are complaining that the new blood collection device introduced 6 months ago is difficult to use for blood draws and has resulted in an increase in needlestick injuries (NSIs). The IP is working with Occupational Health to evaluate the problem and would like to compare NSI rates before and after implementation of the device. Which of the following would be the most useful denominator in order to calculate useful data? a. Phlebotomist employee hours at work (full-time equivalents) b. Number of occupied beds (or licensed beds) c. Number of patients (average daily census) d. Number of blood collection devices used or purchased - ANS D. Number of blood collection devices used or purchased Rationale: The denominator should represent the potential for exposure to sharps. There are many possible denominators that may be used, and each will provide a different view of the sharps injury situation in the facility. A device based rate can be used to compare needlestick risk from different devices and to evaluate the effectiveness of the product design. Because blood draws may be performed by nurses, phlebotomists, or physicians, total device-associated needlestick injuries since implementation of the new product will provide the most useful data. After an incident in which human milk from one mother was mistakenly fed to another mother's infant, the infection preventionist (IP) is tasked with leading a team to determine why the event occurred and how it can be prevented from happening again in the future. This type of analysis is known as: a. Root cause analysis (RCA) b. Gap analysis c. Strengths-weaknesses-opportunities-threats (SWOT) analysis d. Failure mode effect analysis (FMEA) - ANS a. Root cause analysis (RCA) A major difference between a prospective and a retrospective study is that the prospective study: a. Requires a relatively small number of subjects b. Is usually used for testing initial hypotheses c. May require a long follow-up period d. Is usually less costly - ANS c. May require a long follow-up period An IP subscribes to several peer-reviewed journals. As she reviews published articles describing research findings, what question should she ask before incorporating the conclusions/findings of the article into the infection prevention program: a. Was the appropriate study design used and are the conclusions reasonable? b. Is the author well known and well published? c. Does the article state how to contact the author(s) with questions? d. Are the findings described in tables or graphs and easily understandable? - ANS A. Was the appropriate study design used and are the conclusions reasonable? Improved hydrogen peroxide contains: a. Anionic and/or nonionic surfactants b. Glutaraldehyde c. Peracetic acid d. Chlorine - ANS A . Anionic and/or nonionic surfactants Rationale: Improved hydrogen peroxide contains very low levels of anionic and/or nonionic surfactant in an acidic product that act with hydrogen peroxide to produce microbial activity. A healthcare facility is undergoing extensive renovation. Surveillance for which of the following organisms would be particularly important during any construction or renovation project in a healthcare facility? a. MRSA, VRE, and other MDROs b. Legionella and Aspergillus c. Gram-negative bacilli d. Mycobacterium abscessus - ANS b. Legionella and Aspergillus An outbreak of norovirus in an LTCF would most likely have an epidemiological curve (EPI curve) that: a. Indicated a common source of infection b. Indicated a propagated source of infection c. Indicated a point source of infection d. Indicated a common vehicle of infection - ANS b. Indicated a propagated source of infection Which of the following aid in the diagnosis of pseudomembranous colitis (PMC)? 1) Colonoscopic biopsy of lesions 2) Raised antibody levels in blood to Clostridium difficile toxin 3) Positive blood culture for Clostridium difficile 4) Stool assays for Clostridium difficile a. 1, 2 b. 2, 3 c. 3, 4 d. 1, 4 - ANS D 1, 4 Rationale: Pseudomembranous colitis (PMC) is an acute colitis characterized by the formation of an adherent inflammatory membrane (pseudomembrane) overlying sites of mucosal injury. Clostridium difficile infection is responsible for the majority of cases of PMC and for as many as 20 percent of cases of antibiotic-induced diarrhea without colitis. The method of choice fore establishing the diagnosis is done by stool assays for C. difficile toxins or by colonoscopy. Unused alcohol swabs that are placed on top of a dialysis machine in an active dialysis unit: a. Should be discarded b. May be returned to the common area c. Must be cleaned before being used on another patient d. Should only be used on patients with that dialysis machine - ANS A. Should be discarded Rationale: There has been transmission of Hepatitis B and Hepatitis C in dialysis settings, which necessitates rigorous infection control practices. Any medications or patient care supplies such as tape, alcohol swabs, and syringes that come into contact with a dialysis machine should be discarded. Which of the four clinical variables that determine the probability of infection would the IP be targeting when reviewing preoperative chlorhexidine gluconate (CHG) bathing instructions that have been given to the preoperative patient population? a. Inoculum of bacteria b. Virulence of bacteria c. Adjuvants in the microenvironment d. Efficiency of host defenses - ANS A. Inoculum of bacteria The risk for SSI is related to the number of microorganisms contaminating the wound. A preoperative antiseptic shower or bath decreases skin microbial colony counts Which of the following is an example of surveillance on a process indicator? a. The incidence rate of Clostridium difficile in the Bone Marrow Transplant Unit b. The rate of hand hygiene compliance in the Bone Marrow Transplant Unit c. The number of sharp object injuries in the month of May in the Bone Marrow Transplant Unit d. The prevalence of vancomycin-resistant enterococci (VRE) in the Bone Marrow Transplant Unit - ANS B. The rate of hand hygiene compliance in the Bone Marrow Transplant Unit Which of the following statements are true regarding consent to immunization? 1) Some states allow personal belief exemptions 2) Federal regulations require Informed consent 3) All states allow medical exemptions for persons with medical contraindications to vaccination 4) Vaccine recipients must receive Vaccine Information Statements (VISs) a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4 - ANS C. 1, 3, 4 An infant in the Neonatal ICU (NICU) has been diagnosed with Malassezia furfur fungemia. What is the most likely source of the infection? a. Intravenous lipid infusions b. A healthcare worker's false fingernails c. Commercial powdered infant formula d. Respiratory transmission from a colonized family member or healthcare worker - ANS A. Intravenous lipid infusions Rationale: M. furfur is fungemia that is most often associated with lipid infusions. A patient is admitted with skin and soft tissue injury from a cat bite. The most likely organism involved in the infection would be: a. Pasteurella b. Pseudomonas c. E. coli d. Mycobacterium - ANS A. Pasteurella Rationale: Cat bites are more likely to become infected (28 to 80 percent) than dog bites (3 to 18 percent), and Pasteurella spp. (primarily P. multocida) is the most common isolate from dogs as well as cats. 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 - ANS D. 1, 4 Rationale: The temperature of the soaking solution should be monitored and documented to ensure that the temperature of the cleaning solution meets the requirement of the cleaning solution's written IFU. The time the instruments are soaked should also be recorded. The local Health Department informs the IP that a nurse in the CICU has been diagnosed with measles immediately after returning from a trip to Europe. His symptoms began 2 days ago, and he last worked in the unit 9 days ago. The incubation period for measles is 8 to 12 days, and the period of contagion is 1 to 2 days prior to onset of symptoms. How should the IP follow up on this report? a. Determine the susceptibility to measles of all HCP and patients who had contact with the nurse in the past 12 days b. Place all susceptible patients who were cared for by the nurse in Airborne Isolation c. Inform Occupational Health about the infection so that they can furlough the employee for the appropriate amount of time d. The IP does not need to conduct any follow-up - ANS c. Inform Occupational Health about the infection so that they can furlough the employee for the appropriate amount of time An IP wants to make external comparisons of the data collected relating to catheter-associated urinary tract infections (CAUTI) in the Intensive Care Unit (ICU). Which of the formulas below will allow the IP to accurately benchmark against nationally available data? a. The number of ICU patients with urinary catheters in a given month divided by the number of urinary tract infections identified in the same month times 1,000 b. The number of ICU urinary tract infections identified in a given month divided by the number of urinary catheter days in the same month times 1,000 c. The number of urinary catheters used in the ICU in a given month divided by the number of urinary tract infections identified in the same month times 1,000 d. The number of urinary tract infections identified in a given month divided by the total number of patient days in the ICU in the same month times 1,000 - ANS b. The number of ICU urinary tract infections identified in a given month divided by the number of urinary catheter days in the same month times 1,000 Which part of a published research study contains a brief summary of the entire research process with interpretation of data, conclusions from the data, limitations of the study and recommendations for further research? a. Introduction b. Methods c. Results d. Discussion - ANS d. Discussion Toys used for inpatient pediatric patients should ideally be all of the following except: a. New b. Nonporous c. Plush d. Single-patient use - ANS Plush A 16-year-old male is brought to the ER with a fever, and a wound on his left leg that is draining purulent material. He complains of swelling and pain. He is a quarterback on the high school football team and has several turf burns on both legs. Past medical history is insignificant. The culture grows gram-positive organisms in clusters. What is the most likely differential diagnosis? a. Parasitic infection b. Atypical mycobacterium infection c. Methicillin resistant Staphylococcus aureus d. Streptococcus pyogenes - ANS C. Methicillin resistant Staphylococcus aureus Rationale: Athletes can contract CA-MRSA by close skin to skin contact, sharing athletic equipment, sharing towels, razors, or other personal items with someone who has an active infection or who is a carrier. Athletes may get abrasions from artificial turf; these abrasions may serve as an entry point for CA-MRSA. True or False: "The virulence of a disease is enhanced by the ability of the organism to survive in the external environment for a prolonged time—and if it can be spread by airborne contact." - ANS True