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| Section | Weight | Objectives |
|---|---|---|
| Prevention and Control of Transmission of Infectious Agents | 28% | - Cleaning, disinfection, and sterilization - Antimicrobial stewardship - Isolation and patient placement - Hand hygiene and aseptic techniques - Standard and transmission-based precautions |
| Education, Research, and Quality Improvement | 9% | - Performance measurement and quality improvement - Regulatory and accreditation compliance - Evidence-based practice and research application - Development and delivery of education programs |
| Employee and Occupational Health | 10% | - Exposure management and post-exposure prophylaxis - Immunization programs - Health screening and surveillance - Workplace safety policies |
| Identification of Infectious Disease Processes | 19% | - Microbiology and pathogenesis - Risk factors and transmission mechanisms - Epidemiologic principles - Emerging and re-emerging pathogens |
| Surveillance and Epidemiologic Investigation | 24% | - Data collection, validation, and analysis - Benchmarking and reporting - Surveillance system design and implementation - Outbreak investigation and response |
| Environment of Care | 10% | - Safety and risk assessment - Waste management and environmental services - Water and air quality management - Facility design, construction, and renovation |
CIC学習教材の練習試験や模擬試験はみんなにとって重要です。今のリビジョン条件はCIC試験に参加する良い機会です。したがって、レビュープランを調整するために、CICの各練習問題を要約することが不可欠です。今、私たちはCIC実際試験を模擬するためにオンラインテストエンジンとWindowsソフトウェアを追加しました。
質問 # 281
An infection preventionist (IP) is notified that a patient who underwent an endoscopic brain biopsy the night before has been diagnosed with prion disease. Because the diagnosis was thought to be unlikely but possible at the time of the biopsy, the endoscope was sequestered. The endoscope manufacturer's instructions for reprocessing indicate that the endoscope can be reprocessed using high-level disinfection or low-temperature sterilization. The IP should recommend that the endoscope be:
正解:D
解説:
The CBIC Certified Infection Control Exam Study Guide (6th edition) identifies prion diseases (such as Creutzfeldt-Jakob disease) as unique and extremely challenging from an infection prevention standpoint due to the extraordinary resistance of prions to conventional disinfection and sterilization methods. Prions are not destroyed by standard high-level disinfection, low-temperature sterilization, ethylene oxide, or hydrogen peroxide gas plasma, even when manufacturer instructions for use suggest these methods for routine pathogens.
Invasive neurologic procedures involving high-risk tissues (brain, spinal cord, posterior eye) pose the greatest transmission risk. When a reusable device such as an endoscope is used on high-risk tissue in a patient with known or suspected prion disease, and the device cannot tolerate validated prion-inactivation protocols, the Study Guide recommends removal from service and disposal.
While harsh chemical treatments such as 1N sodium hydroxide or high-concentration bleach combined with extended steam sterilization may be effective for heat-resistant surgical instruments, flexible endoscopes and similar devices cannot safely undergo these processes without damage. Therefore, reprocessing is not acceptable in this scenario.
Autoclaving alone and low-temperature sterilization methods are ineffective against prions. As a result, the safest and recommended action is to bag the device as biohazardous waste and discard it, preventing any risk of iatrogenic transmission.
For the CIC exam, this question tests recognition that manufacturer IFUs do not supersede prion-specific infection prevention guidance, and patient safety requires device destruction when prion exposure cannot be reliably mitigated.
質問 # 282
An infection preventionist (IP) is reviewing blood cultures and notices several results with Arcanobacterium, coagulase-negative Staphylococcus, and Corynebacterium. What action is needed from the IP?
正解:A
解説:
The CBIC Certified Infection Control Exam Study Guide (6th edition) emphasizes that certain organisms commonly recovered from blood cultures-such as Arcanobacterium, coagulase-negative Staphylococcus, and Corynebacterium-are frequently associated with skin contamination rather than true bloodstream infection. When multiple blood cultures yield these organisms, the infection preventionist must assess whether the findings represent contamination related to collection practices rather than immediately assuming infection or outbreak.
The most appropriate action is to collaborate with the laboratory manager and clinical teams to evaluate potential trends, specimen collection techniques, and changes in practice. This includes reviewing blood culture contamination rates, assessing skin antisepsis procedures, evaluating staff competency, and determining whether there has been an increase associated with a specific unit, shift, or collection method.
Surveillance data and laboratory quality indicators are essential tools in this evaluation.
Option A is incorrect because results should never be disregarded without assessment. Option B is premature, as the organisms listed are not typical outbreak pathogens and require further analysis before escalation.
Option C is inappropriate because these organisms do not automatically meet criteria for healthcare- associated bloodstream infection without supporting clinical evidence.
This scenario reflects a core CIC exam concept: infection preventionists must apply epidemiologic principles, collaborate with laboratory services, and use data-driven analysis to differentiate contamination from infection and to guide quality improvement efforts.
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質問 # 283
The degree of infectiousness of a patient with tuberculosis correlates with
正解:B
解説:
The infectiousness of tuberculosis (TB) is directly related to the number of Mycobacterium tuberculosis organisms expelled into the air by an infected patient.
Step-by-Step Justification:
* TB Transmission Mechanism:
* TB spreads through airborne droplet nuclei, which remain suspended for long periods.
* Factors Affecting Infectiousness:
* High bacterial load in sputum: Smear-positive patients are much more infectious.
* Coughing and sneezing frequency: More expelled droplets increase exposure risk.
* Environmental factors: Poor ventilation increases transmission.
Why Other Options Are Incorrect:
* A. Hand hygiene habits: TB is airborne, not transmitted via hands.
* B. Presence of acid-fast bacilli (AFB) in blood: TB is not typically hematogenous, and blood AFB does not correlate with infectiousness.
* C. Tuberculin skin test (TST) >20 mm: TST indicates prior exposure, not infectiousness.
CBIC Infection Control References:
* APIC Text, "Tuberculosis Transmission and Control Measures".
質問 # 284
Following recent renovations on an oncology unit, three patients were identified with Aspergillus infections.
The infections were thought to be facility-acquired. Appropriate environmental microbiological monitoring would be to culture the:
正解:B
解説:
The scenario describes an outbreak of Aspergillus infections among three patients on an oncology unit following recent renovations, with the infections suspected to be facility-acquired. Aspergillus is a mold commonly associated with environmental sources, particularly airborne spores, and its presence in immunocompromised patients (e.g., oncology patients) poses a significant risk. The infection preventionist must identify the appropriate environmental microbiological monitoring strategy, guided by the Certification Board of Infection Control and Epidemiology (CBIC) and CDC recommendations. Let's evaluate each option:
* A. Air: Aspergillus species are ubiquitous molds that thrive in soil, decaying vegetation, and construction dust, and they are primarily transmitted via airborne spores. Renovations can disturb these spores, leading to aerosolization and inhalation by vulnerable patients. Culturing the air using methods such as settle plates, air samplers, or high-efficiency particulate air (HEPA) filtration monitoring is a standard practice to detect Aspergillusduring construction or post-renovation in healthcare settings, especially oncology units where patients are at high risk for invasive aspergillosis. This aligns with CBIC's emphasis on environmental monitoring for airborne pathogens, making it the most appropriate choice.
* B. Ice: Ice can be a source of contamination with bacteria (e.g., Pseudomonas, Legionella) or other pathogens if improperly handled or stored, but it is not a typical reservoir for Aspergillus, which is a mold requiring organic material and moisture for growth. While ice safety is important in infection control, culturing ice is irrelevant to an Aspergillus outbreak linked to renovations and is not a priority in this context.
* C. Carpet: Carpets can harbor dust, mold, and other microorganisms, especially in high-traffic or poorly maintained areas. Aspergillus spores could theoretically settle in carpet during renovations, but carpets are not a primary source of airborne transmission unless disturbed (e.g., vacuuming). Culturing carpet might be a secondary step if air sampling indicates widespread contamination, but it is less direct and less commonly recommended as the initial monitoring site compared to air sampling.
* D. Aerators: Aerators (e.g., faucet aerators) can harbor waterborne pathogens like Pseudomonas or Legionella due to biofilm formation, but Aspergillus is not typically associated with water systems unless there is significant organic contamination or aerosolization from water sources (e.g., cooling towers). Culturing aerators is relevant for waterborne outbreaks, not for an Aspergillus outbreak linked to renovations, making this option inappropriate.
The best answer is A, culturing the air, as Aspergillus is an airborne pathogen, and renovations are a known risk factor for spore dispersal in healthcare settings. This monitoring strategy allows the infection preventionist to confirm the source, assess the extent of contamination, and implement control measures (e.g., enhanced filtration, construction barriers) to protect patients. This is consistent with CBIC and CDC guidelines for managing fungal outbreaks in high-risk units.
:
CBIC Infection Prevention and Control (IPC) Core Competency Model (updated 2023), Domain IV:
Environment of Care, which recommends air sampling for Aspergillus during construction-related outbreaks.
CBIC Examination Content Outline, Domain III: Prevention and Control of Infectious Diseases, which includes environmental monitoring for facility-acquired infections.
CDC Guidelines for Environmental Infection Control in Healthcare Facilities (2022), which advocate air culturing to detect Aspergillus post-renovation in immunocompromised patient areas.
質問 # 285
Therapeutic antimicrobial agents should be used when
正解:C
解説:
Therapeutic antimicrobial agents should ideally be pathogen-directed to minimize resistance, side effects, and treatment failure. Once the causative pathogen and its antimicrobial susceptibilities are known, the most narrow-spectrum, effective agent should be used.
Why the Other Options Are Incorrect?
* A. The infecting agent is unknown - Empiric therapy may be necessary initially, but definitive therapy should be based on pathogen identification.
* B. The patient's illness warrants treatment prior to culture results - This applies to empiric therapy, but not to definitive antimicrobial selection.
* C. The patient's symptoms suggest likely pathogens - Clinical presentation guides empiric treatment, but definitive therapy should follow culture and susceptibility testing.
CBIC Infection Control Reference
APIC emphasizes the importance of selecting antimicrobials based on pathogen identification and susceptibility testing to prevent antimicrobial resistance.
質問 # 286
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