CIC

Question 1

A measure of dispersion that reflects the variability in values around the mean is called the:
a. Variance
b. Standard deviation
c. Range
d. Bell curve

Answer 1

b. Standard deviation

Question 2

Which of the following statistical terms would be appropriate when comparing the incidence of lung cancer in a population of smokers compared with the incidence in a nonsmoking population?
A. Odds ratio
B. Relative risk
C. Attack rate
D. Prevalence rate

Answer 2

Answer: B. Relative risk

Rationale: Relative risk is a ratio that shows the risk of developing a disease or infection in a population exposed to a causative agent compared with the risk for developing the same entity in a population that is not exposed to that agent. Because RR involves two ratios, that of the event probability in the exposed group divided by that in the unexposed group, it is also known as the risk ratio.

Question 3

Your healthcare organization is building a new facility and you have been consulted on the requirements for negative pressure in each area. According to the most recent Facility Guidelines Institute (FGI), which of the following require negative pressure:
1. ER waiting room
2. Trauma room
3. Janitor’s closets
4. Newborn ICU

A. 1,2
B. 2,4
C. 3,4
D. 1,3

Answer 3

Answer: D. 1,3

Rationale: According to the FGI Guidelines, ER waiting rooms and Janitor’s closets are examples of rooms in hospitals and outpatient facilities that should be negatively pressurized with respect to adjacent areas.

Question 4

The IP receives a call from the ER about a 38-year-old male with a 4-week history of cough and fever. He has just returned from an extended trip to the southwestern United States. Coccidioidomycosis is on the list of possible diagnoses. Which of the following is true regarding the epidemiology of coccidioidomycosis?
A. Coccidioides spp. are usually found at high elevations
B. Coccidioides spp. are usually found in wet climates
C. Up to 50 percent of people in endemic areas have been exposed to Coccidioides spores
D. Coccidioides spp. are found on the surface of the soil

Answer 4

C. Up to 50 percent of people in endemic areas have been exposed to Coccidioides spores

Question 5

Hydrogen peroxide vapor (HPV) has been shown to be effective for decontamination of patient rooms and is known to kill spores and other microbes. Despite its benefits, there are some drawbacks to using HPV. Which of the following could be a major drawback to using HPV to clean patient rooms?

A. It is effective in decontaminating surfaces but not equipment
B. It leaves a residue that, over time, can damage equipment in the room
C. It lengthens room turnover because it takes a prolonged period of time to complete room treatment
D. It is most effective for areas closer to the unit and less effective around the edges of the room

Answer 5

C. It lengthens room turnover because it takes a prolonged period of time to complete room treatment

Question 6

The frequency of new cases of a disease or condition in a specific population during a limited period is ______________.
A. Case definition
B. Distribution
C. Attack rate
D. Incidence rate

Answer 6

Answer: C. Attack rate

Rationale: Attack rate, in epidemiology, the proportion of people who become ill with (or who die from) a disease in a population initially free of the disease. The term attack rate is sometimes used interchangeably with the term incidence proportion. Attack rates typically are used in the investigation of outbreaks of disease, where they can help identify exposures that contributed to the illness (e.g., consumption of a specific food). The attack rate is calculated as the number of people who became ill divided by the number of people at risk for the illness.

Question 7

A microbe that can grow in the absence of Oxygen but is also able to utilize Oxygen for growth is
A. Aerobe
B. Obligate Anaerobe
C. Facultative anaerobe
D. Microaerophilic Anaerobe

Answer 7

C. Facultative anaerobe

Question 8

Which of the following statements is true when the prevalence of a disease is very low?
A. The sensitivity of a diagnostic test is greatly increased
B. The specificity of a diagnostic test is much greater
C. The negative predictive value of a diagnostic test is very low
D. The positive predictive value of a diagnostic test is lowered

Answer 8

D. The positive predictive value of a diagnostic test is lowered

Question 9

Which of the following statements are true about bloodborne pathogens and occupational exposure in a healthcare setting? (pick 2)
1. Hepatitis B virus may be transmitted to susceptible healthcare personnel by percutaneous or mucosal exposure to infectious blood or body fluids.
2. The risk of healthcare personnel acquiring HIV occupationally depends on the type of the exposure, but, on the average is about 0.3 percent after percutaneous injury.
3. Post exposure prophylaxis are recommended after exposure to Hepatitis C virus positive blood.
4. Saliva, sputum, sweat, tears, and urine are considered potentially infectious even in the absence of visible blood.

Answer 9

Answer: 1,2

Rationale: There is currently no PEP for HCV. Visible blood has to be present to warrant saliva, sputum, tears, sweat and urine potentially infectious.

Question 10

How long should a varicella zoster virus (VZV) ‐susceptible employee be furloughed after exposure to a pediatric patient with primary chicken pox?
A. Days 5‐10 after exposure
B. Days 8-21 after exposure
C. Days 1‐7 after exposure
D. Furlough only if employee develops rash

Answer 10

Answer: B. Days 8-21 after exposure

Rationale: Employee must be furloughed during VZV incubation period

Question 11

What of the following questions should be asked when evaluating results from a research study?
1) Were the instruments valid for the study?
2) Is this a peer-reviewed research journal?
3) Was the sample representative of the intended population?
4) Do the conclusions prove the hypothesis?

A. 1, 2, 3
B. 2, 3, 4
C. 1, 3, 4
D. 1, 2, 4

Answer 11

A. 1, 2, 3
1) Were the instruments valid for the study?
2) Is this a peer-reviewed research journal?
3) Was the sample representative of the intended population?

Question 12

Microorganisms are grown on culture media made of an agar base. Additive to media vary according to growth requirements of organism and/or the desire to select out a specific organism. Fastidious organisms require ________ media, and _________ media is used to inhibit normal commensals.
1. Differential
2. Enriched
3. Selective
4. Nutrient broth
5. Synthetic sheep blood ager

A. 1,3
B. 2,3
C. 5,1
D. 3,4

Answer 12

B. 2,3

2. Enriched
3. Selective

Question 13

Which of the following vaccines would be recommended for a pregnant healthcare worker?
A. Zoster (shingles)
B. Tetanus, diphtheria, and pertussis (Tdap)
C. Measles, mumps, rubella (MMR)
D. Varicella

Answer 13

Answer B. Tetanus, diphtheria, and pertussis (Tdap)

Rationale: Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine is recommended before pregnancy, during pregnancy, or immediately postpartum.

Question 14

A urine specimen collected from an indwelling urinary catheter was sent to the laboratory for culture and sensitivity testing. Culture results reported a colony count of 50,000 CFU/mL of Escherichia coli. Sensitivity testing reported resistance to cephalosporin and sensitivity to ciprofloxacin. This organism is an example of:
A. Methicillin resistance
B. Aminoglycoside resistance
C. Extended-spectrum beta-lactam (ESBL) resistance
D. Quinolone resistance

Answer 14

C. Extended-spectrum beta-lactam (ESBL) resistance

Question 15

What is the appropriate temperature for vaccines that require refrigeration?
A. 46°F to 55°F (8°C to 13°C)
B. 25°F to 35°F (-4°C to 2°C)
C. 25°F to 45°F (-4°C to 7°C)
D. 35°F to 46°F (2°C to 8°C)

Answer 15

D. 35°F to 46°F (2°C to 8°C)

Question 16

Which of the following statements about disinfectants is true?
A. Low and intermediate‐level disinfectants are registered with the FDA
B. Disinfectants are more environmentally friendly than detergents
C. Disinfectants have a kill time of 1 minute
D. Blood and protein inactivate many disinfectants

Answer 16

Answer: D. Blood and protein inactivate many disinfectants

Rationale: Blood and protein inactivate many disinfectants; therefore, organic material must be removed before application.

Question 17

An inpatient facility with less than 200 beds cares for more than 3 tuberculosis patients a year. Which of the following testing schedule is indicated according to the CDC?

A. TB testing should occur at baseline
B. TB testing should occur at baseline with further testing only with exposures
C. TB testing should occur at baseline then annually
D. TB testing should occur at baseline then every 8 to 10 weeks until evidence of transmission has ceased

Answer 17

Answer: C. TB testing should occur at baseline then annually

Rationale: The three TB screening risk classifications are low risk, medium risk, and potential ongoing transmission. The classification of medium risk should be applied to settings in which the risk assessment has determined that HCWs will or possibly will be exposed to people with TB disease or to clinical specimens that might contain M. tuberculosis.

Question 18

What class of chemical indicators is the Bowie‐Dick test?

A. Class 1
B. Class 2
C. Class 3
D. Class 4

Answer 18

Answer: B. Class 2

Rationale: AAMI ST79, ST41, and ST58 have defined six classes of CIs: Class 1 (process indicators), Class 2 (Bowie‐Dick tests), Class 3 (single‐variable indicators), Class 4 (multivariable indicators), Class 5 (integrating indicators), and Class 6 (emulating indicators).

Question 19

The Institute for Healthcare Improvement uses the Model for Improvement – a two-part model designed to accelerate improvement for healthcare processes and outcomes. What are the key component areas of this model?

1) Setting aims, establishing measures, selecting changes
2) Plan-do-study-act
3) Contemplation, action, termination
4) Perceived seriousness and cues to action

A. 1, 2
B. 2, 3
C. 3, 4
D. 1, 4

Answer 19

A. 1, 2

1) Setting aims, establishing measures, selecting changes
2) Plan-do-study-act

Question 20

The IP is stratifying post surgical wound infection data by classification status. Which of the following is classified correctly as clean‐contaminated (class II)?

A. Bowel resection for peritonitis in 72‐year‐old female
B. Closed reduction of transverse fracture in 85‐year‐old male post fall
C. Elective thoracotomy with left upper lobectomy in 48‐year‐old smoker
D. Emergency splenectomy post motor vehicle accident in 18‐year‐old man

Answer 20

Answer: C. Elective thoracotomy with left upper lobectomy in 48‐year‐old smoker

Rationale: Clean‐contaminated or class II surgical wounds may involve entry into parts of the body that normally contain flora, such as the respiratory or urinary tracts; however, in order to qualify as class II, such procedures must be elective and not violate aseptic technique nor show evidence of an infectious process.

Question 21

Most regulations related to the handling or disposal of infectious or regulated medical waste are defined at the

A. Federal level
B. Local level
C. Regional level
D. State level

Answer 21

Answer: D. State level

Rationale: Most regulations related to the handling or disposal of infectious or regulated medical waste are defined at the state level, usually by the state health department.

Question 22

An IP is reading a journal article that states that the data the authors collected are normally distributed. What does this mean?

A. When the data are plotted on a curve, it is skewed
B. The mean is less than the median
C. The skewness value is equal to 1
D. The mean, median, and mode of the data are equal

Answer 22

D. The mean, median, and mode of the data are equal

Question 23

What are the important characteristics adult learners have that must be considered?

1. Open‐minded
2. Concrete thinkers
3. Resistant to change
4. Goal oriented

A. 1,2
B. 2,3
C. 3,4
D. 1,4

Answer 23

Answer: C. 3,4

Rationale: Adults are characterized by maturity, self‐confidence, autonomy, solid decision‐making, and are generally more practical, multi‐tasking, purposeful, self‐directed, experienced, and less open‐minded and receptive to change.

Question 24

Which of the following defines the minimal inhibitory concentration (MIC)?

A. The lowest concentration of a drug that inhibits infection
B. The lowest concentration of a drug that kills the pathogen
C. The lowest concentration of a drug that kills the host
D. The lowest concentration of a drug that prevents growth of a particular organism

Answer 24

Answer: D. The lowest concentration of a drug that prevents growth of a particular organism

Rationale: The minimum inhibitory concentration (MIC) is the lowest concentration of a chemical that prevents visible growth of a bacterium

Question 25

Which of the following are the initial steps in preparing a strategic plan for an infection prevention program?

1. Formulate a mission/vision statement
2. Develop an annual plan
3. Articulation of goals
4. Obtain feedback from key stakeholders

A. 1,2
B. 2,3
C. 3,4
D. 1,4

Answer 25

Answer: D. 1,4

Rationale: The first step in the strategic planning process is to address the questions “Where are we?” and “What do we have to work with?” Answering the question of what we have to work with involves consideration of strengths and weaknesses and determination of how to capitalize on strengths. The next step in the process is answering “Where do we want to be?” As the articulated vision stems from the values of those involved in the process, it is essential that this step involve all of those who will have a stake in the achieving the vision. The vision is then translated into a mission statement: a broad, comprehensive statement of the purpose program.

Question 26

There has been a local bioterrorism event and three healthcare personnel were exposed to inhalation anthrax. They have been decontaminated and are taking PEP, and they would like to return to work. The incubation period of inhalation anthrax is usually about 7 days but can be as long as 2 months. What should the IP’s recommendation be regarding work restrictions for these employees?

A. They will not be allowed to return to work for the duration of the 2-month incubation period
B. They will not be allowed to return to work for the duration of prophylactic treatment
C. They may return to work but must wear respiratory protection while in the facility
D. They may return to work with no restrictions

Answer 26

D. They may return to work with no restrictions

Question 27

You notice there are four new Clostridium difficile infections on the same hallway in the telemetry unit. Fearing this may be an outbreak, what is the first step that MUST be done before anything else?

A. Performing a Literature Review
B. Establishing an Initial Case Definition
C. Confirming Presence of an Outbreak
D. Alerting Key Partners About the Investigation

Answer 27

Answer: C. Confirming Presence of an Outbreak

Rationale: Outbreaks are defined simply as an increase over the expected occurrence of an event. When a possible outbreak is reported, the initial step in the investigation is to confirm that what is being reported indeed represents an increase in the outcome.

Question 28

A patient is admitted with an ulcer on her thumb and swelling of regional lymph glands. The provisional diagnosis is ulceroglandular tularemia. Which of the following is the most likely reservoir for the causative organism?

A. Arthropods
B. Contaminated water
C. Rabbits and rodents
D. Soil

Answer 28

Answer: C. Rabbits and rodents

Rationale: The bacterium that causes tularemia is highly infectious and can enter the human body through the skin, eyes, mouth, or lungs. F. tularensis bacteria can be transmitted to humans via the skin when handling infected animal tissue. In particular, this can occur when hunting or skinning infected rabbits, muskrats, prairie dogs and other rodents.

Question 29

Which of the following means translating the message into verbal and nonverbal symbols to communicate with the receiver:

A. Encoding
B. Decoding
C. Channel
D. Feedback

Answer 29

Answer: A. Encoding

Rationale: Encoding is the process of transferring the information you want to communicate into a form that can be sent and correctly decoded at the other end. Your success in encoding depends partly on your ability to convey information clearly and simply, but also on your ability to anticipate and eliminate sources of confusion (for example, cultural issues, mistaken assumptions, and missing information.) A key part of this is knowing your audience.

Question 30

Which of the following statements about outbreak investigations is true?

A. A single case of an unusual disease does not constitute an outbreak
B. A cluster is not considered an outbreak
C. A pseudo‐outbreak is an increase in positive cultures / tests without clinical disease
D. Outbreaks can only occur in areas under surveillance in a facility.

Answer 30

Answer: C. A pseudo‐outbreak is an increase in positive cultures / tests without clinical disease

Rationale: A pseudo‐outbreak is a term generally applied to situations in which there is a rise in test results without actual clinical disease

Question 31

A design meeting is reviewing the new lay out of the preparation and packing area in the sterile processing department. What should the IP recommend?

1. Area should have a positive airflow
2. Minimum of 8 air exchanges per hour
3. Humidity should be between 20‐40%
4. Return air registers should be at or near floor level

A. 1,2
B. 2,3
C. 3,4
D. 1,4

Answer 31

Answer: D. 1,4

Rationale: Sterilization, preparation, packaging and sterile storage are considered clean areas and should have positive airflow ventilation. Soiled and decontamination areas should be under negative pressure. Each area should have a minimum of 10 air exchanges per hour. Humidity should be between 30 and 60%. Return air registers (i.e., exhaust ducts) shall be at or near floor level, thereby facilitating the installation and effective maintenance of any filtering systems.

Question 32

An increase in HAI Clostridium difficile (C.diff) cases throughout the hospital has prompted the IP to conduct a literature review. The IP noticed that each study mentioned antibiotic usage as a potential risk factor for C.diff infections in hospitalized patients. The IP observes that this data meets the temporality criteria for causality developed by Austin Bradford Hill. Which of the following statements exemplifies the criteria for temporality?

A. There should be coherence between known information about the biological spectrum of the disease and the associated factor
B. The association in question should also be biologically plausible in light of current knowledge.
C. The incidence of disease should be higher in those who are exposed to the factor under consideration than in those who are not exposed
D. Exposure to the hypothesized causal factor must precede the onset of disease.

Answer 32

Answer: D. Exposure to the hypothesized causal factor must precede the onset of disease.

Rationale: Hill’s criteria for causality use modern epidemiological methods to determine whether a factor is causal for a given disease. According to the temporality criteria, exposure always precedes the outcome. If factor “A” is believed to cause a disease, then it is clear that factor “A” must necessarily always precede the occurrence of the disease.

Question 33

Recipients of allogenic hematopoietic stem cell transplantation (HSCT) should be placed in rooms with how many air exchanges per hour?

a. 3
b. 5
c. 10
d. 12

Answer 33

d. 12

Recipients of allogenic hematopoietic stem cell transplantation should be placed in rooms with at least 12 air exchanges per hour or point-of-service HEPA filtration that has 99.97% efficiency capable of removing particles at least 3 mcm in size. Patients are especially at risk for infections caused by Aspergillus, so air quality should be monitored, although routine environmental sampling is not required. Aseptic technique should be meticulously maintained and visitors instructed in hand hygiene and standard precautions.

Question 34

Because of the increased risk of infection with parenteral nutrition, the maximum infusion time for a parenteral lipid bag to run is:

a. 6 hours
b. 12 hours
c. 18 hours
d. 24 hours

Answer 34

b. 12 hours

Because of the increased risk of infection with parenteral nutrition, the maximum infusion time for a parenteral lipid bag to run is 12 hours because lipid emulsions pose the greatest risk of contamination with bacteria or fungi because they are alkaline and isosmotic. Amino acid/dextrose solutions (with or without lipids) should infuse no longer than 24 hours. Amino acid/ dextrose solutions can support fungal growth but are less likely to support bacterial growth than lipid emulsions or total nutrient admixtures.

Question 35

If a breastfeeding mother develops mastitis, the most likely cause is:

a. infant colonized with Staphylococcus aureus
b. inadequate cleansing of breast
c. maternal flora invading nipple
d. contaminated breast pump

Answer 35

a. infant colonized with Staphylococcus aureus

If a breastfeeding mother develops mastitis, the most likely cause is that the infant is colonized with Staphylococcus aureus. About 50 percent of neonates become colonized with Staphylococcus aureus within a few days of birth, and these rates increase if hospitalization is prolonged or the infant is placed in a NICU. The child can become colonized from maternal transmission, but in most cases the transmission is from other sources, and the infant passes the infection into the breast while breastfeeding, resulting in mastitis.

Question 36

A disabled patient has a service animal (a German Shepherd) and insists the dog be allowed to stay in the hospital room to assist the patient. The correct response in collaboration with risk management is to:

a. make arrangements to accommodate the animal
b. inform the patient that the animal is not allowed in the hospital
c. provide alternative assistance for the patient
d. advise the patient’s nurses to care for the animal as well as the patient

Answer 36

a. make arrangements to accommodate the animal

If a disabled patient has a service animal and insists the animal be allowed to stay in the hospital room to assist the patient, the correct response in collaboration with risk management is to make arrangements to accommodate the animal because the law states that service animals are allowed in public places, and this includes health care facilities. Health care providers should have no direct contact with the animal; if the patient is not able to attend to the animal’s needs for food, water, and elimination, then a person who can assist in these duties must be identified.

Question 37

If hair removal is required for a surgical procedure, the BEST method is to:

a. shave hair with razor immediately before incision
b. remove hair with a depilatory the night before surgery
c. remove hair with clippers the night before surgery
d. remove hair with clippers immediately before incision

Answer 37

d. remove hair with clippers immediately before incision

If hair removal is required for a surgical procedure, the best method is to remove the hair with clippers immediately before the incision because clippers cause the least trauma. Removing hair at the surgical site may not reduce SSIs and, in fact, may increase the risk of infection. Shaving should not be used because it often results in slight nicks and abrasions to the skin. Any hair removal should be done immediately before the incision and never the day before.

Question 38

The infection prevention and control plan for an ambulatory surgery center (ASC) should be evaluated:
I. annually.
II. monthly.
III. when risks change.
IV. when staff members change.

a. I and III only
b. II and III only
c. I, III, and IV only
d. III and IV only

Answer 38

a. I and III only

I and III. The infection prevention and control plan for an ambulatory surgery center (ASC) should be evaluated annually and when risks change in order to determine strengths, weaknesses, and barriers, and to carry out revision. The infection prevention and control plan should outline surveillance activities, processes for investigating outbreaks, methods of communicating findings to staff members, and mechanisms for reporting to other organizations, such as governmental agencies, health departments, and accrediting organizations. The governing body of the ASC should have an active role in evaluation of the plan.

Question 39

How long after exposure to hepatitis A virus (HAV) are immunoglobulin M antibodies to HAV (IgM anti-HAV) detectable in the blood?

a. 48 hours
b. 7 days
c. 3 weeks
d. 1-10 weeks

Answer 39

c. 3 weeks

Immunoglobulin M (IgM) antibodies to HAV (IgM anti-HAV), which are used to diagnose hepatitis A, are detectable in the blood 3 weeks after exposure and at the onset of jaundice. The IgM anti-HAV titer begins to fall over a period of 4-6 weeks and is no longer detectable in the blood after 6-12 months. At onset of jaundice, IgG anti-HAV is also present and will continue to remain positive throughout the person’s life, indicating immunity to HAV.

Question 40

For patients who require hemodialysis, which type of vascular access device (VAD) poses the lowest risk of infection?

a. arteriovenous graft
b. subclavian catheter
c. arteriovenous fistula
d. right internal jugular catheter

Answer 40

c. arteriovenous fistula

For patients who require hemodialysis, the type of vascular access device that poses the lowest risk of infection is the arteriovenous fistula, which should be placed in the arm rather than the thigh. Patients with catheters have 7 times the risk of infection, and subclavian catheters have a high risk for central venous thrombosis and stenosis. Additionally, patients with chronic kidney disease should have vascular access preserved and AV fistulas created as soon as possible.

Question 41

A distribution curve that has a skew value of +3 will exhibit:

a. a normal bell-shaped curve
b. a flattened curve
c. an enlarged tail to the right
d. an enlarged tail to the left

Answer 41

c. an enlarged tail to the right

A distribution curve that has a skew value of +3 will exhibit an enlarged tail to the right, indicating that there are more data than expected on the right or positive end of the distribution curve. The skew is positive when the mean is greater than the median and negative when the mean is lesser than the median. A value of 0 indicates the normal bell-shaped curve with no skew. A negative value indicates that the values skew to the left.

Question 42

How long is the typical incubation period after exposure to West Nile virus?

a. 1-2 days
b. 2-14 days
c. 2-3 days
d. symptoms occur almost immediately following exposure

Answer 42

b. 2-14 days

The incubation period, or the time between exposure and the onset of symptoms, for West Nile virus is typically anywhere from 2 to 14 days. WNV is not spread from person to person, but infection can occur from blood transfusions, organ transplants, and breastfeeding. Only about 20% of those who are infected become symptomatic with West Nile fever, usually with flu-like symptoms such as fever, myopathy, malaise, nausea, vomiting, rash, fatigue, and headache. A small number (less than 1%) of patients develop West Nile encephalitis, meningitis, or polio-like flaccid paralysis.

Question 43

According to the Occupational Safety and Health Administration (OSHA), if health care personnel believe that working conditions are potentially unsafe, the health care personnel have the right to:
I. leave the job.
II. request an OSHA inspection.
III. demand transfer to a different unit.
IV. inform employer of potentially unsafe conditions.

a. II and IV only
b. I, II, and IV only
c. II, III, and IV
d. I, II, III, and IV

Answer 43

a. II and IV only

II and IV. According to OSHA, if health care personnel believe that working conditions are potentially unsafe, the health care personnel have the right to request an OSHA inspection and inform employer of potentially unsafe conditions. While personnel have the right to leave the job if working conditions are unsafe, this does not apply to potentially unsafe conditions. However, health care personnel can insist on using PPE while at work, although the health care personnel may be required to provide rationale if the PPE is in excess of recommended PPE for the situation.

Question 44

Ambulatory care centers are required to have:

a. one full-time equivalent IP staff person
b. affiliation with a facility with a IP staff person
c. all staff trained in infection control and prevention
d. one person available and trained in infection prevention

Answer 44

d. one person available and trained in infection prevention

Ambulatory care centers are required to have one person available to the facility and trained in infection prevention. This person must be employed by the facility or regularly available, but the law does not require the person to be employed full-time at the facility or trained as an IP. The ambulatory care center should have infection prevention and occupational health programs, supplies to ensure compliance with standard precautions, and written infection prevention policies and procedures.

Question 45

In an outbreak investigation, a line listing and an epidemic curve have been completed. Before generating hypotheses, the next step should be to:

a. establish a plan for methodology
b. conduct a literature review
c. conduct a brainstorming session
d. determine what resources are needed

Answer 45

b. conduct a literature review

After the line listing and epidemic curve have been completed, the IP should have enough preliminary information to conduct a literature review to identify other outbreaks with similar profiles. If the causative agent has not been identified, then the review may help to identify potential causes of the outbreak. If the causative agent has been identified, then the literature review may provide helpful information about possible sources of contamination and approaches to field studies and containment.

Question 46

Which of the following diagnostic tests for Clostridium difficile has the BEST sensitivity and specificity?

a. Nucleic acid amplification, including PCR
b. Glutamate dehydrogenase
c. Toxigenic culture
d. Toxin enzyme immunoassay (EIA)

Answer 46

a. Nucleic acid amplification, including PCR

A nucleic acid amplification test, including the PCR, has both excellent specificity and sensitivity, and yields rapid results but is expensive. The EIA is inexpensive and rapid but has poor sensitivity and specificity. The glutamate dehydrogenase test is rapid and inexpensive. It has good sensitivity and negative predictive value but very poor specificity and needs a second test to detect toxins. The toxigenic culture has excellent sensitivity and good specificity but requires a second test for toxins and requires 3-4 days to complete.

Question 47

In a long-term care facility with 120 patients, in the month of September (30 days), 5 patients out of the total of 20 patients in the Alzheimer unit each had 1 fall. What is the fall incidence rate per 1000 patient days in September on the Alzheimer unit?

a. 41.6
b. 25
c. 8.3
d. 1.4

Answer 47

c. 8.3

[5/(2030)]1000

Question 48

When considering reprocessing medical devices, most facilities will require:

a. a contract with third-party reprocessing organization
b. increased training for staff regarding reprocessing procedure
c. hiring of additional personnel
d. improved sterilization, processing equipment

Answer 48

a. a contract with third-party reprocessing organization

When considering reprocessing of medical devices, most facilities will require a contract with a third-party reprocessing organization. This is recommended because facilities, such as hospitals, usually do not have industrial quality sterilization and processing procedures, increasing the risk of infection and liability. Third-party reprocessing organizations are regulated by the FDA and must adhere to strict guidelines. Each facility considering reprocessing should specify the medical devices that can be reprocessed and procedures to prepare the equipment for reprocessing.

Question 49

Burn patients are especially at risk of infection because of:
I. overall immunosuppression.
II. loss of skin barrier.
III. use of invasive devices.
IV. microorganism’s development of resistance to topical antibiotics.

a. I and II only
b. II, III, and IV only
c. I, II, and III only
d. I, II, III, and IV

Answer 49

d. I, II, III, and IV

I, II, III, and IV. One of the primary problems that increase risk of infection in burn patients is overall immunosuppression, with both humoral and cellular immunity impairment. The loss of skin barrier allows for colonization of pathogenic organisms. Invasive devices, such as intravenous lines, add further risk. While topical antibiotics are commonly used to reduce bacterial counts of the tissue, microorganisms often develop resistance to these antibiotics, making treatment difficult and resulting in outbreaks of resistant organisms.

Question 50

Which agency regulates medical waste and incinerators?

a. CDC
b. OSHA
c. FDA
d. EPA

Answer 50

d. EPA

The Environmental Protection Agency (EPA) regulates medical waste and incinerators as well as disinfectants used on hard surfaces (such as cleaning products) and antimicrobial pesticides. The FDA also has a regulatory role in germicides, such as antiseptics, but the EPA regulates those that may impact the environment under the Federal Insecticide, Fungicide, and Rodenticide Act. The FDA and EPA jointly test all registered sterilants and disinfectants, including those products whose manufacturers make claims about the product’s ability to control tuberculosis.

Question 51

An epidemic curve that rises slowly and then plateaus rather than peaks over an extended period likely represents:

a. common continuous exposure
b. common intermittent exposure
c. propagated source
d. point source

Answer 51

a. common continuous exposure

An epidemic curve that rises slowly and then plateaus rather than peaks over an extended period likely represents common continuous exposure with the plateau demonstrating a continuous ongoing spread of the infection. An epidemic curve is a graphic representation of an outbreak that can show patterns, including the magnitude of the infection and the presence of outliers. The epidemic curve helps to identify incubation periods. The general shape of the curve (peaked, plateaued) helps to identify the type of outbreak.

Question 52

If a mother is pumping breast milk for a hospitalized infant, what is the optimal period of time the milk should be stored in a refrigerator at 4 °C (39 °F) or less?

a. 6-8 hours
b. 24-48 hours
c. 72 hours
d. 8-10 days

Answer 52

c. 72 hours

If a mother is pumping breast milk for a hospitalized infant, the optimal period of time the milk should be stored in a refrigerator at 4 °C (39 °F) or less is 72 hours. However, if stored under very clean conditions, the milk may be stored for 5-8 days. If mothers are transporting the milk from home, it must be transported at 4 °C (39 °F), so mothers must be educated about the need to use freezer packs during transportation or should be provided a site for pumping at the hospital.

Question 53

Which of the following indicators is likely to require the longest time period for collection of surveillance data?

a. CLABSI
b. CAUTI
c. CDI
d. VRSA

Answer 53

d. VRSA

VRSA infections are quite rare, so this indicator is likely to require the longest time period for collection of surveillance data. Longer time periods are needed to determine rates of infection for procedures that rarely take place or for infections that rarely occur, so the IP must take into consideration the usual rates of occurrence when determining the time period needed for surveillance. Data are usually collected for time periods ranging from a month to a year.

Question 54

When collecting data about surgical site infections from electronic health records and databases, the best resource to assist is:

a. nursing department.
b. IT department
c. risk management department
d. surgical department

Answer 54

b. IT department

The IT department is the best resource when collecting data about surgical site infections from electronic health records and databases because the information technology personnel should be able to assist in directly downloading the data into a computerized surveillance database. The IT department should also be contacted prior to purchase of any surveillance software to determine if it is compatible with existing systems or if existing software and databases can be used for data collection and surveillance activities.

Question 55

The primary purpose of the just-in-time inventory concept is to:

a. minimize costs of inventory
b. maintain better control of inventory
c. prevent waste of medical supplies
d. ensure adequate stock of medical supplies

Answer 55

a. minimize costs of inventory

The primary purpose of the just-in-time inventory concept is to minimize costs of inventory. Just-in-time inventory closes part of the gap between expenditures and reimbursement because supplies are ordered according to use instead of keeping a large stock of supplies on hand. This also reduces costs associated with out-of-date supplies that need to be returned, disposed of, or re-sterilized. Just-in-time inventory also reduces the space needed for supplies as well as the labor costs associated with maintaining supplies.

Question 56

In a suspected outbreak, which of the following is an example of passive case finding?

a. Ask the laboratory to identify further cases
b. Use a diagnostic test to screen at-risk individuals
c. Notify health care providers to be alert for additional cases
d. Examine county surveillance data

Answer 56

d. Examine county surveillance data

Passive case finding takes advantage of information that is already available, such as examining county surveillance data. Passive case finding tends to be less costly and less time-consuming than active case finding but may miss many cases. Examples of active case finding include asking the laboratory to identify further cases, using diagnostic tests to screen at-risk individuals, and notifying health care providers to be alert for additional cases. Active case finding may also include making appeals through the media, such as television, radio, and newspapers.