CIC Certification Pre-test Flashcards
Which of the following statements about the susceptibility of antimicrobial-resistant bacteria to disinfectants is true?
a. Antimicrobial-resistant bacteria are more susceptible to disinfectants than non-resistant bacteria.
b. Antimicrobial-resistant bacteria are less susceptible to disinfectants than non-resistant bacteria.
c. Antimicrobial-resistant bacteria equally susceptible to disinfectants as non-resistant bacteria.
d. Antimicrobial-resistant bacteria require higher levels of disinfectant to become inactivated than antimicrobial-sensitive bacteria.
Rationale
c. While microbes may develop reduced susceptibility to disinfectants, this is not a concern from a practical standpoint because the concentrations of disinfectants used in practice are still sufficient to be effective against even less susceptible microbes. Antimicrobial-resistant bacteria are no more likely to develop reduced susceptibility to disinfectants than antimicrobial-sensitive bacteria are.
What is the purpose of bacterial biofilm formation?
a. It prevents adherence to the cell wall.
b. Biofilm kills competing organisms.
c. It is the cell’s preferred method of growth.
d. Biofilm decreases the organism’s concentration.
Rationale
c. Biofilm supports bacterial growth, increasing their concentration by attaching to cell walls.
A patient presents to your facility with a month-long cough, weight loss, fever, night sweats, and hemoptysis. A sputum Gram stain is reported as “many white blood cells (WBCs), no organisms seen”; and an acid-fast bacilli (AFB) sputum smear is reported as “many AFB seen.” The chest x-ray shows upper-lobe cavitary lesions. Which of the following organisms is the most likely cause of the patient’s symptoms?
a. Mycobacterium fortuitum
b. Mycobacterium abscessus
c. Mycobacterium chelonae
d. Mycobacterium tuberculosis
Rationale
d. Mycobacterium tuberculosis infections include symptoms of a cough lasting longer than three weeks, weight loss, fever, night sweats, and hemoptysis along with cavitary lesions on chest x-rays. M. abscessus and M. chelonae are associated with skin and soft tissue infections. M. fortuitum may cause infections and skin abscesses at the site of trauma and has been associated with nail salons.
Which of the following is best suited to minimizing exposure to infectious agents while handling soiled healthcare textiles?
a. Paper bags can be used to contain wet or soiled textiles.
b. Assume soiled healthcare textiles are contaminated and follow standard precautions (SP).
c. Sort soiled textiles and rinse them in patient-care areas.
d. Put clean linen from isolation rooms with other clean linen.
Rationale
b. To minimize exposure to infectious agents while handling soiled healthcare textiles, healthcare personnel (HCP) shouldn’t sort or rinse soiled textiles in patient-care areas. All all linen from isolation rooms should be treated as though it is soiled linen. Tear-resistant and leak-proof collection bags or containers should be used to contain wet or soiled textiles.
Which of the following educational methods is best suited to conveying education and training to adult learners?
a. Passive learning environment
b. Written goals or objectives for education
c. Directives without rationale
d. Active learning environment
Rationale
d. A number of different learning styles exist, but an active learning environment is best suited to adult learners because it allows the IP to engage them in a way that the information and training taught is more likely to be retained.
A research study explored and described the experiences and perceptions of infection preventionists (IPs) working in acute care hospitals during the coronavirus disease 2019 (COVID-19) global pandemic. What type of research study does this describe?
a. Case-control
b. Qualitative
c. Quantitative
d. Quasi-experimental
Rationale
b. Qualitative research gathers participants’ experiences, perceptions, and behavior. In contrast, quantitative research measures variables using a numerical system, analyzes them using any of a variety of statistical models, and reports relationships and associations among the studied variables. Quasi-experiments are studies that aim to evaluate interventions but that do not use randomization. A case-control study is a retrospective, observational study that compares two existing groups.
A dialysis patient is admitted to the hospital with a red, tender catheter insertion site. Which of the following is the most likely explanation for what happened to the patient?
a. They showered without covering the catheter site with an impermeable dressing.
b. They went out for dinner with some family members.
c. They visited a friend who is suffering from congestive heart failure.
d. They replaced the compromised catheter dressing as instructed.
Rationale
a. Patients should be instructed not to submerge their catheter or insertion site in water, but they may still shower if the catheter and insertion site are covered with an impermeable dressing. Replacing a compromised dressing should not cause an infection to develop nor should visiting friends or going out for dinner.
Which of the following precautions should be used for an immunocompromised patient suspected of having cryptococcal meningitis?
a. Airborne precautions for 24 hours after antibiotic is started if the patient is improving
b. Mask worn when within three feet from the patient’s bed
c. Standard precautions (SP) for staff and patient’s family
d. Contact precautions for staff; patient’s family restricted from visiting other patients
Rationale
c. Cryptococcosis, or cryptococcal disease, is a potentially fatal fungal disease caused by two species of Cryptococcus: C. neoformans and C. gattii. Cryptococcal meningitis is believed to result from dissemination of the fungus from either an observed or unappreciated pulmonary infection. Fungal meningitis is not transmitted from person to person and requires the use of SP.
An infection preventionist (IP) has identified an increase in catheter-associated urinary tract infections (CAUTIs) on the orthopedic unit. What are the action plan elements for reducing CAUTIs on this unit?
a. Device use, goals, strategy, person responsible, time frame, and measurements
b. Infection outcome/risk item, goals, strategy, person responsible, time frame, and measurements
c. Infection outcome/risk item, purpose, strategy, person responsible, time frame, and measurements
d. Infection outcome/risk item, goal, strategy, unit responsible, time frame, and measurements
Rationale
b. By developing a comprehensive surveillance plan, the IP can clearly identify actions needed to improve patient outcomes. The plan should include details about infection outcomes, plan goals and strategy, the person responsible, time frame, and measurements.
While performing routine surveillance, an infection preventionist (IP) identifies an alarming increase in the number of streptococcal infections, which are all related to one department in their facility. The rate of infection was above the expected norm for the population. Which of the following terms describes this situation?
a. Pandemic
b. Whole-house surveillance
c. Passive surveillance
d. Outbreak
Rationale
d. An outbreak is an increase in the number of identified cases above what is normal or expected for a given population.
An infection preventionist (IP) is evaluating a demolition project in an area of the hospital adjacent to the oncology department. Which of the following actions should the IP take to mitigate the risk?
a. Perform environmental sampling.
b. Consult with the engineering department to evaluate the air-handling system.
c. Recommend adding high-efficiency particulate air (HEPA) filers to the heating, ventilation, and air conditioning (HVAC) system.
d. Transfer all immunocompromised patients to another unit.
Rationale
b. Construction, renovation, repair, excavation, and demolition activities in hospitals and other healthcare facilities require planning and coordination among departments to minimize the infection risk for immunocompromised patients. The infection control risk assessment (ICRA) must be developed with the input of HVAC and plumbing engineers, architects, facility managers, medical staff, clinical department heads, safety specialists, and other individuals with a vested interest in the project.
Surgeons at a local hospital are hesitant to accept the benefits of patient normothermia during operative procedures. The surgery department chair asks the infection preventionist (IP) to perform a literature review of the evidence for perioperative normothermia. Which of the following levels of evidence should the IP present to the chair?
a. Case-control studies
b. Quasi-experimental studies
c. Randomized clinical trials
d. Case reports
Rationale
c. Among the options listed, randomized clinical trials are the most reliable because they provide the strongest evidence; they are, therefore, the most convincing. Only systemic reviews of multiple studies are considered more reliable.
Which of the following terms describes the harmfulness of a pathogen?
a. Pathogenicity
b. Inoculum
c. Virulence
d. Infectivity
Rationale
c. There are several characteristics that influence the transmissibility of an organism and its ability to cause disease. One of these is virulence, which is the ability of an organism to grow and multiply.
An infection preventionist (IP) is called to the day hospital care center for a possible outbreak of hepatitis A (HAV). The public health nurse is assisting the IP in investigating the outbreak. Prophylactic immunoglobulin would confer what type of immunity to the care workers and noninfected children?
a. Passive immunity
b. Active immunity
c. Herd immunity
d. Nonspecific immunity
Rationale
a. Passive immunity is the transfer of antibody produced by one human (or other animal) to another. Passive immunity provides protection against some infections, but this protection is temporary. The antibodies will degrade during a period of weeks to months, and the recipient will no longer be protected.
You receive a preliminary microbiology report from a blood culture that notes the presence of a few alpha-hemolytic Streptococcus spp. Which of the following organisms is most likely to be identified in the final report?
a. Streptococcus agalactiae
b. Streptococcus pyogenes
c. Group G Streptococcus
d. Streptococcus pneumoniae
Rationale
d. Streptococcus pneumoniae is an alpha-hemolytic Streptococcus. Streptococcus pyogenes (group A Streptococcus), Streptococcus agalactiae (group B Streptococcus), and group G Streptococcus are all beta-hemolytic streptococci.
Why is handwashing preferred over the use of alcohol-based hand sanitizer (ABHS) after caring for a patient with Clostridioides difficile?
a. C. difficile spores are resistant to alcohol.
b. Soap and water are more readily available in all settings than ABHS.
c. ABHS can be irritating to the skin when spores are present.
d. Workers are more compliant with handwashing.
Rationale
a. Spores are resistant to alcohol. Handwashing must be used to remove spores since alcohol does not effectively kill C. difficile spores.
During a recent hurricane, a hospital experiences significant water intrusion impacting all levels of safe operation. Incident command has made the decision to evacuate all patients. There are currently six patients on isolation precautions. To speed the evacuation along, the infection preventionist (IP) was asked to transport as many patients in pairs as possible. Based on the information in the below, what should the IP recommend?
Patient A
Adult with history of methicillin-resistant Staphylococcus aureus (MRSA) admitted for knee replacement; no known active infection.
Patient B
Adult with lower airway infection; ruling out TB, test results are not available.
Patient C
Adult with active vancomycin-resistant enterococci (VRE) infection in a foot wound.
Patient D
Child with chickenpox; most lesions have healed.
Patient E
Adult with C. difficile infection; last diarrheal episode was 18 hours ago.
Patient F
Child with diarrhea of unknown etiology; last episode was 18 hours ago.
a. Cover remaining lesions of patient D and the foot wound of patient C, then transport together.
b. Transport patient E and F together as they are both 18 hours from last diarrheal episode.
c. Cover patient C’s wound and transport with patient A.
d. Cover remaining lesions of patient D and transport with patient F.
Rationale
c. Patients B and D both require airborne precautions and should not be transferred with any other patients. Patients with C. difficile infections (CDI) should remain in isolation until a minimum of 48 hours after their last diarrheal episode; as such, they should only be cohorted with other patients with confirmed CDIs.
Patients with contained wounds may be cohorted with other patients with minimal risk. Of the six patients, only patients A and C could be safely transported together.
An infection preventionist (IP) receives a call from the operating room (OR) that there is a water leak in the sterile storage area. Which of the following actions should the IP recommend OR staff take?
a. Items should be returned to the sterile processing department for complete re-sterilization (clean, wash, wrap, and sterilize).
b. Items should be sent out to another company for re-sterilization.
c. The outer wrap should be removed and re-sterilized.
d. Items should be left to air dry before next use.
Rationale
a. Sterile supplies can no longer be considered sterile if there is water contamination in the storage area. The Centers for Disease Control and Prevention (CDC) and the Association for the Advancement of Medical Instrumentation (AAMI) recommend that such items be re-sterilized.
What is the purpose of a surveillance program?
a. To provide overall data to guide the quality improvement department’s efforts
b. To provide actionable data by identifying all potential risks.
c. To provide actionable data by identifying all unknown and known risks
d. To provide actionable data by identifying the most important risks
Rationale
b. An effective surveillance program should include information for detecting outbreaks and instituting control measures to prevent disease transmission based on all potential risks that might be encountered within a given healthcare setting.
Cavitation is a term used to describe the cleaning process used during which of the following procedures?
a. Pasteurization
b. High-level disinfection
c. Cleaning by ultrasonic washer
d. Cleaning by washer-disinfector
Rationale
c. Ultrasonic energy is an effective technology routinely used to clean surgical and dental instruments prior to terminal sterilization. Ultrasonic cleaning uses cavitation bubbles induced by high frequency pressure (sound) waves to agitate a liquid. The agitation produces high forces on contaminants adhering to substrates like metals, plastics, glass, rubber, and ceramics. This action also penetrates blind holes, cracks, and recesses.
What percentage of data will fall within two standard deviations of the mean in a normal distribution?
a. 75%
b. 99%
c. 68%
d. 95%
Rationale
d. In a normal distribution, 95% of data fall within two standard deviations of the mean.
**What is the central line device utilization ratio for a facility that has 200 central line days and 8,000 patient days?
a. 0.025
b. 2.5
c. 0.25
d. 0.05
Rationale
a. The device utilization ratio allows the infection preventionist to monitor outcomes or processes; it is given as a percent by dividing the patient days by the number of device days. In the above example, the device utilization ratio is 200 / 8000 = 0.025, or 2.5%.
How should drying be facilitated to reduce microbial contamination and proliferation in endoscopes?
a. Blow dry with compressed air, rinse with tap water, and hang vertically to dry.
b. Blow compressed air through the channel and rinse with 70% ethyl or isopropyl alcohol.
c. Rinse with tap water and blow compressed air through the channels.
d. Rinse with alcohol, hang vertically to dry, and store in a case to keep clean.
Rationale
b. Endoscope disinfection or sterilization with a liquid chemical sterilant involves five steps after leak testing:
- Clean mechanically all internal and external surfaces, including brushing internal channels and flushing each internal channel with water and a detergent or enzymatic cleaners (leak testing is recommended for endoscopes before immersion).
- Disinfect by immersing endoscope in high-level disinfectant (or chemical sterilant) and perfusing the disinfectant (to eliminate air pockets and ensure contact of the germicide with the internal channels) into all accessible channels—such as the suction/biopsy and air/water channels—and then expose for the product-specific recommended time.
- Rinse the endoscope and all channels with sterile water, filtered water (commonly used with automated endoscope reprocessors [AERs]), or tap water (i.e., high-quality potable water that meets federal clean water standards at the point of use).
- Flush the insertion tube and inner channels with alcohol.
- Dry with forced air before storage.
Which of the following statements describes a disadvantage of polymerase chain reaction (PCR) testing?
a. Antibiotic susceptibility testing cannot be performed.
b. It cannot be used after antibiotics have been administered.
c. Low numbers of organisms cannot be detected.
d. Dead organisms cannot be detected.
Rationale
a. Antibiotic testing cannot be performed using PCR. The other statements listed above describe advantages of PCR testing: It can be used to identify organisms that are dead, present in low numbers, or have been treated with antibiotics.
Early-onset neonatal sepsis is most likely caused by which of the following organisms?
a. Bacteroides fragilis
b. Candida spp.
c. Group B streptococcus
d. N. gonorrhea
Rationale
c. Early-onset neonatal sepsis is usually caused by organisms acquired intrapartum, and symptoms appear within six hours of birth. Most cases are caused by Group B streptococcus and gram-negative enteric organisms (predominantly E. coli).
What is the first thing that an infection preventionist (IP) should do when a sterilizer issue is identified?
a. Contact risk management.
b. Unwrap then rewrap instruments.
c. Take the sterilizer out of service.
d. Inspect instruments to see whether they need to be recleaned.
Rationale
c. It is vital that problematic sterilizers be removed from service to prevent any further risk of contaminated instruments being used.
Which of the following work restrictions would be required for a healthcare worker (HCW) with a confirmed case of herpes simplex on their hands (herpetic whitlow)?
a. HCW should be excluded from patient contact and the patient’s environment until their lesions heal.
b. HCW can work in the patient’s environment but should be excluded from patient contact until their lesions heal.
c. HCW should not be restricted from work.
d. HCW should cover their herpetic lesions while giving patient care.
Rationale
a. Herpetic whitlow can be spread by patient contact or environmental contamination. As such, infected HCWs should be excluded from patient contact and the patient’s environment until their lesions heal.
When should an infection prevention and control (IPC) risk assessment be updated?
a. When leadership requires it
b. Before an announced visit by an accreditation organization
c. When new risks arise or already identified risks change
d. When a complaint is filed against the facility
Rationale
c. Risk assessment is an ongoing part of an infection prevention and control program (IPCP). The risk assessment should be updated whenever new risks arise (e.g., new procedures, changes in patient population, or a pandemic), or when there are changes to already identified risks.
The value analysis committee is reviewing a new product for cleaning equipment at the point of use. Which of the following product factors is most important to consider as it relates to infection prevention and control (IPC)?
a. Storage
b. Contact time
c. Cost
d. Disposal
Rationale
b. Although all options represent important factors in the consideration of a new cleaning product, the main IPC concern is staff compliance: shorter contact times are associated with higher cleaning compliance rates.
Which of the following methods is preferred when point-of-use cleaning is required?
a. Ultrasonic cleaner
b. Washer-decontaminator
c. Ultraviolet (UV) light disinfection
d. Manual cleaning
Rationale
d. Some equipment—such as endoscopes and surgical instruments—are fragile or difficult to clean. For these reasons, mechanical cleaning methods are not feasible and point-of-use cleaning should be done instead; manual cleaning is preferred method for point-of-use cleaning. Point-of-use cleaning also prevents the formation of biofilms.
What kind of gene acquisition occurs when environmental deoxyribonucleic acid (DNA) enters a bacterial cell?
a. Transduction
b. Replication
c. Conjugation
d. Transformation
Rationale
d. Transformation occurs when naked DNA from the environment enters a bacterium. Conjugation is when all or part of plasmid is transferred from donor to recipient cell. Transduction occurs when DNA is transferred from one bacterial cell to another via a virus capable of infecting bacteria.
A patient colonized with vancomycin-resistant enterococci (VRE) is receiving hemodialysis on an outpatient basis. Which of the following statements is true about this patient?
a.They cannot be cohorted with known VRE patients in a specific area of the dialysis unit.
b. They have a lower risk of bacteremia then other patients with central catheters.
c. They should be observed for pyrogenic reactions from 24–48 hours following hemodialysis.
d. They have the potential for fecal contamination of the environment.
**Rationale **
d. Patients with VRE may be cohorted. Although many patients become colonized by patient-to-patient spread, environmental contamination does inevitably occur; and significant reservoirs may, therefore, exist and persist in clinical care areas, such as a dialysis unit.
A recent study demonstrated that more than 40 percent of healthcare personnel (HCP) have come to work with flu-like illnesses. Which of the following interventions is most effective at thwarting presenteeism?
a. Implementing mandatory exclusion rules
b. Requiring a medical certificate for absences
c. Restricting paid sick leave
d. Removing systematic processes for screening employees
Rationale
a. Presenteeism occurs when employees go to work despite having a medical illness that prevents them from fully fulfilling their job duties. Policies to prevent presenteeism should include the availability of unrestricted paid sick leave, systematic processes for screening ill employees, and mandatory exclusion rules.
Which of the following measures can help an infection preventionist (IP) to identify whether or not changes to facility practices are leading to intended improvements?
a. Risk measures
b. Strategic measures
c. Outcome measures
d. Process measures
Rationale
c. Outcome measures indicate whether changes are actually leading to improvement—that is, helping to achieve the overall aim of preventing healthcare-associated infections (HAIs); examples include the rate of occurrence of methicillin‐resistant Staphylococcus aureus (MRSA) per 1,000 patient days and the percent of patients with C. difficile-associated diseases.
A data set is comprised of six values: 7, 12, 6, 9, 15, and 11. What is the median for this data set?
a. 11
b. 10
c. 9
d. 13
Rationale
b. The terms mean, median, mode, and range describe properties of statistical distributions. The median is the middle number in a sorted list of numbers; it depends on whether the number of data points is odd or even—if the former, then the median is the value of the middle term; if the latter, then it is the average of the two middle terms.
To calculate the median in this example, the data set is first sorted (6, 7, 9, 11, 12, 15). As there is an even number of terms, the two middle numbers (9 and 11) would be averaged: (9 + 11) / 2 = 10.
If an infection preventionist (IP) helps learners to organize themselves so that they share the responsibility for mutual inquiry, which of the following conditions of adult education is met?
a. The environment is characterized by physical comfort and mutual respect.
b. Learners feel the need to learn.
c. Learners participate actively in the learning process.
d. Learners perceive the goals of learning to be their goals.
Rationale
c. Active learning is the process of learning via engaging with the content. By implementing active learning strategies, students can interact with the material via activities such as completing a task or engaging with their surroundings (e.g., discussions or debates) in ways that promote analytical thought.
The director of the intensive care unit (ICU) asks the infection preventionist (IP) whether ventilator tubing can be reprocessed and reused. Which of the following actions should the IP take?
a. Experiment with different cleaning and disinfection products to identify an appropriate reprocessing method.
b. Defer the question to the respiratory therapy department .
c. Consult with the sterile processing department to determine whether the ventilator tubing can be reprocessed.
d. Review ventilator tubing packaging and the manufacturer’s instructions for use (IFU) to determine whether it is a single-use item or one that can be reprocessed.
Rationale
d. Product packaging and manufacturer’s IFU provide information about whether the product is single-use or multiple-use (i.e., can be reprocessed). The IP is the appropriate subject-matter expert to answer this question for the ICU director since it is an infection prevention and control (IPC) responsibility.
A 50-year-old healthcare worker (HCW) who has never received a pneumococcal conjugate vaccine (PCV) requests information about them. What information about unvaccinated adults receiving PCVs should the IP share with the HCW?
a. That they can receive a single dose of PCV15 followed 12 months later by one dose of PCV23; alternatively, they can receive one dose of PCV20
b. That they should delay receiving any PCV vaccines until they are 65 years old, at which point they can receive any of the available PCVs
c. That they should receive a single dose of PCV23, with no follow-up
d. That they can receive PVC15, PVC20, and PCV23 if they are spaced 12 months apart
Rationale
a. The Centers for Disease Control and Prevention (CDC) recommends that adults aged 18–64 receive a single dose of PCV15 followed 12 months later by one dose of PCV23; alternatively, they can receive one dose of PCV20.
Which of the following is an example of an outcome measure?
a. Rates of healthcare-associated infections (HAIs)
b. Ratio of infectious disease physicians to patients
c. Percentage of patients receiving the pneumococcal vaccine
d. Percentage of patients receiving preoperative antibiotics
Rationale
a. HAIs are examples of undesirable events. The ratio of physicians is an example of a structural measure. The percentage of patients with immunizations or preoperative antibiotics are examples of process measures.
An infection preventionist (IP) is asked to complete an infection control risk assessment (ICRA) for the removal of carpeting outside a patient care area. Which of the following should the IP prioritize highest when assessing this project?
a. Assess the patient care population at risk to determine mitigation strategies.
b. Assess the scope of the overall project.
c. Ensure that the project is done at night.
d. Ensure that the environmental services (EVS) department is informed of cleanup efforts.
Rationale
a. Although all options describe important considerations, the assessment of the patient population at risk is the highest priority for the ICRA as it will inform risk mitigation strategies.
A healthcare worker (HCW) who has not received the hepatitis B (HBV) vaccine has been exposed by needlestick from a patient with known HBV infection. Which of the following post-exposure treatments should the infection preventionist (IP) recommend?
a. Start the HBV vaccine series and administer HBV immune globulin (HBIG) within 24 hours post-exposure.
b. Administer one dose of the HBV vaccine.
c. Post-exposure prophylaxis (PEP) is not recommended.
d. Administer one dose of HBIG within 24 hours post-exposure.
Rationale
a. When an unvaccinated HCW is exposed to HBV, they should be administered the HBV vaccine series and HBIG, preferably within 24 hours post-exposure.
What is the required first step in surgical instrument reprocessing?
a. Low-level disinfection
b. High-level disinfection
c. Immediate-use sterilization
d. Cleaning
Rationale
d. All surgical instruments should be cleaned at the point of use to remove any organic matter. The instruments must then be sterilized. Low- and high-level disinfection are not applicable to surgical instruments.
According to Centers for Disease Control and Prevention (CDC) guidelines, which of the following statements regarding the prevention of surgical site infections (SSIs) is true?
a. Apply antimicrobial agents (e.g., ointments, solutions, or powders) to the surgical incision for the prevention of SSIs.
b. Remove hair at the operative site because its presence might interfere with the surgical operation.
c. Administer preoperative antimicrobial agents only when indicated, based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues after the incision is made.
d. Implement perioperative glycemic control and use blood glucose target levels of less than 200 mg/dL in patients both with and without diabetes.
Rationale
d. Preoperative antimicrobial agents should only be administered when indicated, based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. Antimicrobial agents (e.g., ointments, solutions, or powders) should not be applied to the surgical incision for the prevention of SSIs, and hair should not be removed at the operative site unless its presence will interfere with the operation.
An adenovirus outbreak has been identified in a neonatal intensive care unit (NICU). Epidemiological investigation reveals 18 primary cases among the 22 neonates housed on the unit, 11 secondary cases among the 20 employees who were potentially exposed, and 6 secondary cases among 15 parents who had exposure. What is the secondary attack rate among exposed contacts?
a. 48.6%
b. 55.2%
c. 74.3%
d. 40.5%
Rationale
a. A secondary attack rate represents the probability that an infection occurs among susceptible people within a specific group (e.g., household or close contacts). It is calculated as the number of new cases among contact during the specified time divided by the total number of contacts at risk, multiplied by 100. In this example: ([11 + 6] / [20 + 15]) x 100 = 48.6%.
While performing rounds, an infection preventionist (IP) notices a healthcare worker (HCW) wiping down an endocavitary probe with a low-level disinfectant wipe. What corrective action or feedback should the IP provide to this HCW?
a. Collaborate with the HCW in cleaning the endocavitary probe and explain Bloom’s taxonomy.
b. Explain the Spaulding classification model and review manufacturer’s instructions for use (IFU).
c. Remind the HCW that endocavitary probes should only be sterilized, not disinfected.
d. Do nothing: endocavitary probes are noncritical items and the use of a low-level disinfectant is acceptable.
Rationale
b. Before using semi-critical devices, HCWs must understand the Spaulding classification model and be aware of any manufacturer’s IFU. Sterilization should only be used if recommended by the manufacturer IFU. Bloom’s taxonomy concerns learning behaviors, not cleaning and disinfection protocols.
Statistical tests are used to describe data from research studies. The specific tests used in a study to analyze this data are typically presented in what section of a research paper?
a. Introduction
b. Methods
c. Results
d. Discussion
Rationale
b. The discussion section fits the results of a study into the framework of what is known about the problem and then compares those results to other studies. The introduction of a research study will describe the study’s purpose and rationale. The methods section details the tools and procedures, including statistical tests, used in the study.
An environmental services (EVS) worker vaccinated against hepatitis B (HBV) sustains a needlestick injury while emptying trash. The source patient cannot be identified. Which of the following actions should the infection preventionist (IP) recommended be taken within 72 hours of the needlestick?
a. Provide hepatitis A (HAV) vaccine.
b. Test the worker to establish continued HBV immunity.
c. Perform a baseline human immunodeficiency virus (HIV) test.
d. Provide hepatitis C (HCV) vaccine.
Rationale
c. Post-exposure baseline HIV testing is recommended when the source patient is known to be HIV positive or when the source patient’s HIV status cannot be determined. Workers who have demonstrated HBV immunity after vaccination do not need retesting. There is no HCV vaccine. Testing for HAV, a foodborne pathogen, is not required after needlestick exposures.
An infection preventionist (IP) identifies a trend of norovirus cases presenting to the emergency department (ED). Who should follow up with the community to perform contact tracing and programs for prevention?
a. IP
b. Public health officials
c. ED personnel
d. Chief nursing officer
Rationale
b. The IP performs surveillance within their facility, but they should notify the public health department of any identified trends. Public health officials are then responsible for using the IP’s surveillance findings to prevent community-related infections and trends and to enact public health policies.
A patient presents with mild respiratory allergies and disseminated skin lesions; the presiding physician starts treatment with the antiviral acyclovir. The infection preventionist (IP) is consulted. What precautions should they recommend?
a. Airborne and contact
b. Airborne
c. Contact
d. Droplet and contact
Rationale
a. Shingles (herpes zoster) is a manifestation of a recurrent infection; disseminated presentation requires airborne and contact precautions.
An infection preventionist (IP) is making rounds with nursing representatives to assess compliance with cleaning and disinfection protocols for portable equipment. They observe the use of intravenous (IV) pumps with evidence of surface damage (corrosion). Which of the following steps should the IP take first?
a. Conclude that the corrosion is due to the age of the equipment.
b. Check the expiration date of the disinfecting wipes.
c. Review the IV pump manufacturer’s instructions for use (IFU).
d. Remove the product from use immediately.
Rationale
c. The IV pump manufacturer’s IFU will provide directions for how to clean and disinfect the machine, including the type of products that should be used. If the equipment is not being cleaned and disinfected according to its IFU, the corrosion may be caused by an inappropriate cleaning or disinfecting product. It is not feasible to remove in-use equipment immediately. The expiration date of the disinfecting wipes has no bearing the presence of the corrosion.
Which of the following types of vaccines should be avoided by pregnant healthcare personnel (HCP)?
a. Inactivated vaccines
b. Live-virus vaccines
c. Coronavirus disease 2019 (COVID-19) vaccines
d. All vaccines
Rationale
b. Live-virus vaccines are contraindicated for pregnant women. The other types of vaccines listed are all considered safe during pregnancy.
A patient presenting with pneumonia has a respiratory culture that grows Escherichia coli; susceptibility testing shows resistance to amoxicillin, ceftazidime, ceftriaxone, and ciprofloxacin and sensitivity to amoxicillin-clavulanate, piperacillin-tazobactam, and gentamicin. What precautions should the infection preventionist (IP) recommend for this patient?
a. Droplet
b. Contact
c. Airborne
d. Standard
Rationale
b. The patient is infected with an organism (Escherichia coli) that exhibits extended spectrum beta-lactamase (EBSL), which hydrolyses late generation cephalosporins and penicillins and can be inhibited by clavulanate and tazobactam. The recommended type of precautions for ESBLs is contact.
Which of the following organisms requires a living host to grow and reproduce?
a. Bacteria
b. Viruses
c. Prions
d. Fungi
Rationale
b. Viruses reproduce through the spread of virions, which are inert and do not grow or multiply until they enter a living cell. Virions are taken in by living host cells, where they modify the cell metabolism to produce a new nucleic acid and protein coat. Once the particles are assembled and released by the cell they can invade other host cells.
What do the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) provide to healthcare facilities?
a. Best practice guidelines based on the most up-to-date scientific evidence
b. Requirements that must be followed under penalty of law
c. Authority to follow a regulatory agency
d. Regulations enforceable by legal penalties
Rationale
a. The WHO and CDC do not set laws or regulations. Instead, they provide guidelines based on recognized expert consensus.
During an infection prevention and control (ICP) committee meeting, it is mentioned that the hospital has a low patient influenza vaccination rate and omissions in assessing new admissions for influenza vaccination prior to hospital admission. Which of the following strategies should the infection preventionist (IP) recommend to improve the immunization rate?
a. Encouraging patients to discuss vaccines with their primary care physician
b. Offering all patients vaccine information statements (VISs) upon admission
c. Encouraging nurses to ask patients about their vaccination status upon admission
d. Standing orders for vaccines
Rationale
d. Standing orders for vaccines have been shown to significantly improve the rate of vaccination.
An infection preventionist (IP) should immediately notify public health authorities after receiving which of the following laboratory reports?
a. Four cases of gram-negative bacteria in urine
b. Two cases of Clostridioides difficile from dialysis patients
c. One case of probable Bacillus anthracis from the blood culture of a prominent politician
d. Three cases of Staphylococcus epidermidis in blood cultures
Rationale
c. Bacillus anthracis is the causative organism of anthrax. Anthrax is rare in the US and, when detected, should be reported immediately to public health officials to ascertain whether it is related to bioterrorism.
When making rounds, an infection preventionist (IP) notices that a provider did not perform proper hand hygiene (HH) before quickly stepping out of a patient’s room to answer an urgent call. Such a mistake is known as which of the following types of failure?
a. Skill-based
b. Personal-based
c. Rule-based
d. Knowledge-based
Rationale
a. A skill-based failure is any inadvertent mistake made when conducting a routine or automatic task—as, for example, one due to distraction.
Which of the following items are considered “critical” according to the Spaulding classification?
a. Vascular access devices (VADs), gastrointestinal endoscopes, and laryngoscopes
b. VADs, bedpans, and biopsy probes
c. Bronchoscopes, gastrointestinal scopes, and stethoscopes
d. Blood pressure cuffs, computers, and floors
Rationale
a. According to the Spaulding classification, critical items are those that enter sterile sites, such as VADs, gastrointestinal endoscopes, and laryngoscopes. Semi-critical items enter non-sterile sites or contact mucous membranes. Noncritical items come into contact only with intact skin.
Which of the following learning objectives is based on the cognitive domain?
a. Perform an assessment of the integrity of a central line dressings.
b. Describe the impact of coronavirus disease 2019 (COVID-19) on their practice.
c. Demonstrate the steps of a urinary catheter care bundle.
d. Identify three risk factors for developing a Clostridioides difficile
infection (CDI).
Rationale
d. The three domains of learning are cognitive (thinking/head), affective (feelings/emotions), and psychomotor (physical). The cognitive learning domain involves the intellect—the understanding of information and how that develops through application on a scale that increases from basic recall to complex evaluation and creation. Identifying risk factors is an example of knowledge application.
A patient presents to the emergency department (ED) with diarrhea, nausea, and vomiting. The patient reported eating a premade ham sandwich from a convenience store approximately 10 hours prior. Which of the following organisms is the probable cause?
a. Salmonella enteritidis
b. Shigella sonnei
c. Campylobacter jejuni
d. Listeria monocytogenes
Rationale
d. Ready-to-eat deli meats are a common source of Listeria, and the symptoms of Listeria typically appear 9–48 hours after eating contaminated food. Although Salmonella, Shigella, and Campylobacter all cause similar symptoms, they are not commonly associated with eating ready-to-eat deli meats and their symptoms typically occur 1–2 days after eating contaminated food.
