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| Section | Objectives |
|---|---|
| Environment of Care | - Air and water quality management - Healthcare facility design and risk reduction |
| Occupational Health | - Healthcare worker exposure prevention - Immunization and post-exposure protocols |
| Identification of Infectious Disease Processes | - Pathogenesis of infectious diseases - Chain of infection and transmission routes - Host susceptibility factors |
| Infection Prevention and Control Program Management | - Program development and leadership - Policy and guideline implementation - Regulatory compliance |
| Education, Consultation, and Research | - Evidence-based practice and guideline interpretation - Staff education strategies |
| Cleaning, Disinfection, and Sterilization | - High-level disinfection practices - Environmental cleaning standards - Sterilization methods and validation |
| Surveillance and Epidemiologic Investigation | - Outbreak investigation and response - Healthcare-associated infection surveillance methods - Data collection and analysis |
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263. Frage
At a facility with 10.000 employees. 5,000 are at risk for bloodbome pathogen exposure. Over the past five years, 100 of the 250 needlestick injuries involved exposure to bloodborne pathogens, and 2% of exposed employees seroconverted. How many employees became infected?
Antwort: B
Begründung:
To determine the number of employees whoseroconverted(became infected) after aneedlestick exposure, we use the given data:
* Total Needlestick Injuries:250
* Needlestick Injuries Involving Bloodborne Pathogens:100
* Seroconversion Rate:2%
Calculation:
A black text with black numbers AI-generated content may be incorrect.
Why Other Options Are Incorrect:
* A. 1:Incorrect calculation;2% of 100 is 2, not 1.
* C. 5:Overestimates the actual number of infections.
* D. 10:Exceeds the calculated value based on given data.
CBIC Infection Control References:
* APIC Text, "Occupational Exposure and Seroconversion Risks".
* APIC Text, "Bloodborne Pathogens and Needlestick Injury Prevention"
264. Frage
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?
Antwort: B
Begründung:
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.
265. Frage
A facility performs active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on all patients upon admission and weekly. Twenty-two of the patients with positive cultures for MRSA were transferred from outlying facilities. The following MRSA data for a 3-month period are shown. Review of the data reveals which of the following is increasing?
Antwort: B
Begründung:
The table separates admission cultures from weekly cultures, which is a common surveillance approach to distinguish imported MRSA burden (present on admission) from healthcare acquisition (newly detected later). The admission culture percent positive rises over the three months: 14% (Feb) # 18% (Mar) # 19% (Apr). That pattern indicates an increasing admission prevalence (option B). NHSN MDRO surveillance methods describe admission prevalence as a proxy measure using admission-related data to quantify organisms present at the time of entry into a location/facility.
By contrast, weekly culture positivity-often used as a proxy for on-unit acquisition/transmission when admission screening is in place-decreases: 6% # 5.6% # 4%, so option A is not increasing. The dataset also does not provide information about MRSA infections versus colonization (so C cannot be concluded), nor does it provide a denominator for "compliance" (e.g., expected admissions/weekly screens completed), so D cannot be determined. This interpretation aligns with standard infection prevention use of MRSA surveillance data to track prevalence (burden) versus incidence/acquisition.
266. Frage
One of the elements of antibiotic stewardship is controlling antibiotic use. Which of the following BEST describes a closed formulary?
Antwort: C
Begründung:
Antibiotic stewardship programs are designed to optimize antimicrobial use, improve patient outcomes, reduce antimicrobial resistance, and decrease unnecessary costs. The CBIC Certified Infection Control Exam Study Guide (6th edition) identifies formulary restriction and preauthorization as key core strategies within effective antimicrobial stewardship programs. A closed formulary specifically refers to a system in which access to certain antibiotics is restricted and requires prior approval before dispensing.
In a closed formulary model, prescribers must obtain authorization-often from infectious diseases specialists, pharmacy, or an antimicrobial stewardship team-before selected antimicrobial agents can be used. This approach ensures that high-risk, broad-spectrum, or high-cost antibiotics are used only when clinically appropriate. By requiring approval, the organization promotes judicious antibiotic selection, prevents unnecessary exposure, and supports resistance prevention efforts.
Option B describes de-escalation, which is another stewardship strategy but does not define a closed formulary. Option C refers to antibiotic cycling, a controversial and less-supported strategy. Option D is incorrect because a closed formulary does not merely limit availability; rather, it controls access through approval mechanisms.
For the CIC exam, it is critical to distinguish between stewardship strategies. A closed formulary is best characterized by mandatory approval prior to dispensing, making option A the most accurate answer according to the Study Guide's antimicrobial stewardship framework.
267. Frage
A healthcare worker experiences a percutaneous exposure to a patient with untreated HIV. The next step is to:
Antwort: A
Begründung:
* HIV post-exposure prophylaxis (PEP) should be initiated within 2 hours to be most effective.
* Waiting for results (B) delays critical treatment.
* PEP should always be offered after high-risk exposure, not only if symptoms develop (C).
* Retesting after 6 months (D) is recommended but should not delay PEP initiation.
CBIC Infection Control References:
* APIC Text, "Bloodborne Pathogens and PEP," Chapter 11.
268. Frage
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