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| Section | Weight | Objectives |
|---|---|---|
| Education and Research | 6-9% | |
| Preventing/Controlling the Transmission of Infectious Agents | 17-19% | |
| Employee/Occupational Health | 10-13% | |
| Environment of Care | 10-13% | |
| Management and Communication | 10-13% | |
| Cleaning, Sterilization, Disinfection, Asepsis | 10-13% | |
| Identification of Infectious Disease Processes | 17-19% | |
| Surveillance and Epidemiologic Investigation | 22-26% |
>> CBIC CIC Exam Objectives <<
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NEW QUESTION # 276
Peripherally inserted central catheter (PICC)-associated bloodstream infections (BSIs) have been increasing over the past four months. Which of the following interventions is MOST likely to have contributed to the increase?
Answer: B
Explanation:
Peripherally inserted central catheter (PICC)-associated bloodstream infections (BSIs) are a significant concern in healthcare settings, and identifying factors contributing to their increase is critical for infection prevention. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the
"Surveillance and Epidemiologic Investigation" and "Prevention and Control of Infectious Diseases" domains, which align with the Centers for Disease Control and Prevention (CDC) guidelines for preventing intravascular catheter-related infections. The question asks for the intervention most likely to have contributed to the rise in PICC-associated BSIs over four months, requiring an evaluation of each option based on evidence-based practices.
Option C, "Replacement of the intravenous administration sets every 72 hours," is the most likely contributor to the increase. The CDC's "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (2017) recommend that intravenous administration sets (e.g., tubing for fluids or medications) be replaced no more frequently than every 72-96 hours unless clinically indicated (e.g., contamination or specific therapy requirements). Frequent replacement, such as every 72 hours as a routine practice, can introduce opportunities for contamination during the change process, especially if aseptic technique is not strictly followed. Studies cited in the CDC guidelines, including those by O'Grady et al. (2011), indicate that unnecessary manipulation of catheter systems increases the risk of introducing pathogens, potentially leading to BSIs. A change to a 72- hour replacement schedule, if not previously standard, could explain the observed increase over the past four months.
Option A, "Use of chlorhexidine skin antisepsis during insertion of the PICC," is a recommended practice to reduce BSIs. Chlorhexidine, particularly in a 2% chlorhexidine gluconate with 70% alcohol solution, is the preferred skin antiseptic for catheter insertion due to its broad-spectrum activity and residual effect, as supported by the CDC (2017). This intervention should decrease, not increase, infection rates, making it an unlikely contributor. Option B, "Daily bathing adult intensive care unit patients with chlorhexidine," is another evidence-based strategy to reduce healthcare-associated infections, including BSIs, by decolonizing the skin of pathogens like Staphylococcus aureus. The CDC and SHEA (Society for Healthcare Epidemiology of America) guidelines (2014) endorse chlorhexidine bathing in intensive care units, suggesting it should lower, not raise, BSI rates. Option D, "Use of a positive pressure device on the PICC," aims to prevent catheter occlusion and reduce the need for frequent flushing, which could theoretically decrease infection risk by minimizing manipulation. However, there is no strong evidence linking positive pressure devices to increased BSIs; if improperly used or maintained, they might contribute marginally, but this is less likely than the impact of frequent tubing changes.
The CBIC Practice Analysis (2022) and CDC guidelines highlight that deviations from optimal catheter maintenance practices, such as overly frequent administration set replacements, can increase infection risk.
Given the four-month timeframe and the focus on an intervention's potential negative impact, Option C stands out as the most plausible contributor due to the increased manipulation and contamination risk associated with routine 72-hour replacements.
References:
CBIC Practice Analysis, 2022.
CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2017.
O'Grady, N. P., et al. (2011). Guidelines for the Prevention of Intravascular Catheter-Related Infections.
Clinical Infectious Diseases.
SHEA Compendium, Strategies to Prevent Central Line-Associated Bloodstream Infections, 2014.
NEW QUESTION # 277
During the last week in June, an emergency department log reveals numerous cases of profuse watery diarrhea in individuals 74 years of age and older. During the same time period, four immunocompromised patients were admitted with possible Cryptosporidium. Which of the following actions should the infection preventionist take FIKST?
Answer: B
Explanation:
When an outbreak of infectious disease is suspected, the first step is to conduct an epidemiologic investigation. This begins with characterizing the outbreak by person, place, and time to establish patterns and trends. This approach, known as descriptive epidemiology, provides critical insights into potential sources and transmission patterns.
Step-by-Step Justification:
Identify Cases and Patterns:
The infection preventionist should analyze patient demographics (person), locations of cases (place), and onset of symptoms (time). This helps in defining the outbreak scope and potential exposure sources.
Create an Epidemic Curve:
An epidemic curve helps determine whether the outbreak is a point-source or propagated event. This can indicate whether the infection is spreading person-to-person or originating from a common source.
Compare with Baseline Data:
Reviewing historical data ensures that the observed cases exceed the expected norm, confirming an outbreak.
Guide Further Investigation:
Establishing basic epidemiologic patterns guides subsequent actions, such as laboratory testing, environmental sampling, and surveillance.
Why Other Options Are Incorrect:
B). Increase surveillance facility-wide for additional cases:
While enhanced surveillance is important, it should follow the initial characterization of the outbreak.
Surveillance without a defined case profile may lead to misclassification and misinterpretation.
C). Contact the laboratory to confirm stool identification results:
Confirming lab results is essential but comes after defining the outbreak's characteristics. Without an epidemiologic link, testing may yield results that are difficult to interpret.
D). Form a tentative hypothesis about the potential reservoir for this outbreak:
Hypothesis generation occurs after sufficient epidemiologic data have been collected. Jumping to conclusions without characterization may result in incorrect assumptions and ineffective control measures.
CBIC Infection Control References:
APIC Text, "Outbreak Investigations," Epidemiology, Surveillance, Performance, and Patient Safety Measures.
APIC/JCR Infection Prevention and Control Workbook, Chapter 4, Surveillance Program.
APIC Text, "Investigating Infectious Disease Outbreaks," Guidelines for Epidemic Curve Analysis.
NEW QUESTION # 278
The primary source of organisms that cause surgical silo infections is the
Answer: C
Explanation:
The primary source of organisms causing surgical site infections (SSIs) is the patient's own endogenous flora. Bacteria from the skin, mucous membranes, or gastrointestinal tract contaminate the surgical site, leading to infection. Common pathogens include Staphylococcus aureus, coagulase-negative staphylococci, and Enterobacteriaceae.
Why the Other Options Are Incorrect?
* A. Operating room environment - While environmental contamination can contribute, it is not the primary source.
* B. Operating room personnel - Infection control measures (hand hygiene, gloves, masks) reduce transmission from personnel.
* D. Healthcare personnel's hands - Although hand contamination is a risk, it is secondary to the patient's endogenous flora.
CBIC Infection Control Reference
According to APIC guidelines, the patient's own flora is the primary source of SSIs.
NEW QUESTION # 279
Immediate use steam sterilization is NOT recommended for implantable items requiring immediate use because
Answer: C
Explanation:
The correct answer is C, "results of biologic indicators are unavailable prior to use of the item," as this is the primary reason immediate use steam sterilization (IUSS) is not recommended for implantable items requiring immediate use. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, IUSS is a process used for sterilizing items needed urgently when no other sterile options are available, typically involving a shortened cycle (e.g., flash sterilization). However, for implantable items- such as orthopedic hardware or prosthetic devices-ensuring absolute sterility is critical due to the risk of deep infection. Biologic indicators (BIs), which contain highly resistant spores to verify sterilization efficacy, require incubation (typically 24-48 hours) to confirm the kill, but IUSS does not allow time for BI results to be available before the item is used (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment). This lack of immediate verification poses a significant infection risk, making IUSS inappropriate for implants, as per AAMI ST79 standards.
Option A (the high temperature may damage the items) is a consideration for some heat-sensitive materials, but modern IUSS cycles are designed to minimize damage, and this is not the primary reason for the restriction on implants. Option B (chemical indicators may not be accurate at high temperatures) is incorrect, as chemical indicators (e.g., color-changing strips) are reliable at high temperatures and serve as an immediate check, though they are not a substitute for BIs. Option D (the length of time is inadequate for the steam to penetrate the pack) is not the main issue, as IUSS cycles are optimized for penetration, though the shortened time may be a secondary concern; the unavailability of BI results remains the decisive factor.
The focus on biologic indicator results aligns with CBIC's emphasis on ensuring the safety and sterility of reprocessed medical devices, particularly for high-risk implantable items (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.5 - Evaluate the environment for infection risks). This recommendation is supported by AAMI and CDC guidelines, which prioritize BI confirmation for implants to prevent healthcare-associated infections (AAMI ST79:2017, CDC Sterilization Guidelines, 2019).
References: CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competencies 3.3 - Ensure safe reprocessing of medical equipment, 3.5 - Evaluate the environment for infection risks. AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in health care facilities. CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2019.
NEW QUESTION # 280
The primary source of organisms that cause surgical silo infections is the
Answer: C
Explanation:
The primary source of organisms causing surgical site infections (SSIs) is the patient's own endogenous flora.
Bacteria from the skin, mucous membranes, or gastrointestinal tract contaminate the surgical site, leading to infection. Common pathogens include Staphylococcus aureus, coagulase-negative staphylococci, and Enterobacteriaceae.
Why the Other Options Are Incorrect?
* A. Operating room environment - While environmental contamination can contribute, it is not the primary source.
* B. Operating room personnel - Infection control measures (hand hygiene, gloves, masks) reduce transmission from personnel.
* D. Healthcare personnel's hands - Although hand contamination is a risk, it is secondary to the patient' s endogenous flora.
CBIC Infection Control Reference
According to APIC guidelines, the patient's own flora is the primary source of SSIs.
NEW QUESTION # 281
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