CIC Certification Pre-test Flashcards

Question

**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*

Answer 1

**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*).

Answer 2

**Rationale** c. It is vital that problematic sterilizers be removed from service to prevent any further risk of contaminated instruments being used.

Answer 3

**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.

Answer 4

**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.

Answer 5

**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.

Answer 6

**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.

Answer 7

**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.

Answer 8

**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.

Answer 9

**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.

Answer 10

**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.

Answer 11

**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.

Answer 12

**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.

Answer 13

**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.

Answer 14

**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.

Answer 15

**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.

Answer 16

**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.

Answer 17

**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.

Answer 18

**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.

Answer 19

**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.

Answer 20

**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%.

Answer 21

**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.

Answer 22

**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.

Answer 23

**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.

Answer 24

**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.

Answer 25

**Rationale** a. Shingles (herpes zoster) is a manifestation of a recurrent infection; disseminated presentation requires airborne and contact precautions.

Answer 26

**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.

Answer 27

**Rationale** b. Live-virus vaccines are contraindicated for pregnant women. The other types of vaccines listed are all considered safe during pregnancy.

Answer 28

**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.

Answer 29

**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.

Answer 30

**Rationale** a. The WHO and CDC do not set laws or regulations. Instead, they provide guidelines based on recognized expert consensus.

Answer 31

**Rationale** d. Standing orders for vaccines have been shown to significantly improve the rate of vaccination.

Answer 32

**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.

Answer 33

**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.

Answer 34

**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.

Answer 35

**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.

Answer 36

**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.

Answer 37

**Rationale** c. VRE can spread directly to people who contact VRE-contaminated surfaces. VRE is not spread through the air by coughing or sneezing.

Answer 38

**Rationale** d. According to The Joint Commission (TJC), the process for selecting good core measures for IPC includes four accountability measures: research, proximity, accuracy, and adverse effects.

Answer 39

**Rationale** c. Microbes have differing resistance to sterilization based on their physical and chemical properties. Vegetative bacteria (such as *Staphylococcus aureus*) and lipid or medium-sized viruses (such as HIV) are the least resistant of all microbes to sterilization.

Answer 40

**Rationale** c. A risk assessment can aid the infection preventionist (IP) in identifying potential (and actual) risks and gaps in an IPCP, particularly in regards to patient safety.

Answer 41

**Rationale** b. The EVS director has developed a process measure. Process measures can be used to assess the effectiveness of educational programs and compliance with written protocols.

Answer 42

**Rationale** c. According to the Spaulding classification, semi-critical items are those that enter non-sterile sites or contact mucous membranes, such as a bronchoscope. A blood pressure cuff is an example of a noncritical item, and central lines and prosthetic joints are examples of critical items because they enter sterile sites.

Answer 43

**Rationale** c. A *common-source outbreak* is defined by the CDC as “an outbreak in which a group of persons are all exposed to an infectious agent or a toxin from the same source.” In some common-source outbreaks, case-patients may have been exposed over a period of days or weeks (or longer), as was the case in the outbreak shown above.

Answer 44

**Rationale** a. Peer-reviewed journals are scrutinized by editorial staff and experts in the field before being published. Product brochures and materials provided by manufacturers are designed to promote the unique features of their products. Webinar and online briefings may or may not be reviewed for methods or content.

Answer 45

**Rationale** b. All outbreaks should be reported to the local health department because public health officials can consult on outbreak investigations and provide assistance or support—including laboratory services if needed—during an actual outbreak.

Answer 46

**Rationale** b. Disinfection processes involve the use of liquid chemicals or wet pasteurization. It does not kill bacterial spores, but it does kill all other pathogenic organisms.

Answer 47

**Rationale** a. Antimicrobial prophylaxis is the use of antimicrobials to prevent infection prior to surgery or other procedure. Empiric use is directed at active infections before information on the causative pathogen is available. Therapeutic use is pathogen directed. Diagnostic use targets known diseases.

Answer 48

**Rationale** d. When monitoring and evaluating processes or procedures, the IP should use direct observation and provide immediate feedback to the frontline team. Drafting an email or making a phone call shifts the responsibility to others. Doing nothing could potentially lead to cross-contamination issues.

Answer 49

**Rationale** b. Prevention champions are respected individuals with strong communication skills who are knowledgeable and enthusiastic about the infection prevention and control (IPC). They help to provide feedback and education to HCP when lapses in practices are observed.

Answer 50

**Rationale** a. The word *commensal*, like the word *colonization*, indicates that microorganisms are present in a host without causing symptoms of disease.

Answer 51

**Rationale** d. Quality assurance is a process for achieving quality standards and meeting a level of acceptable patient care. Performance improvement is a proactive, ongoing cycle that focuses on continuous improvement of outcomes, processes, and systems. Both are necessary components of a quality assurance and performance improvement (QAPI) program. Root cause analysis (RCA) is a tool used to seek root causes. A quantitative tool that provides an indication of performance is known as a performance measure.

Answer 52

**Rationale** d. Sterilizer exposure time and temperature, together with the BI testing (e.g., a Bowie–Dick test), should be documented to assist the IP in verifying effective sterilization cycles. The other options provide information that may be useful to know or identify records that should be kept, but they do not directly help to assess the effectiveness of sterilization cycles.

Answer 53

**Rationale** b. Chest x-rays and CT-scans are useful for showing pathology closely associated with TB. Some common findings are cavities, consolidations, nodules, or evidence of disseminated infection. While other indicators of failing health may be present in certain patients, such indicators are not specific to TB.

Answer 54

**Rationale** d. The detection and identification of certain healthcare-associated infections (HAIs)—such as healthcare-associated TB—may suggest an HVAC system malfunction. The other options are unlikely to be the cause of the employee testing positive for LTBI.

Answer 55

**Rationale** a. A case definition is a standard set of clinical criteria that an IP can use to identify additional outbreak cases. In the above example, these criteria will include episodes of vomiting, frequency and consistency of diarrhea, patient location, and a defined time period.

Answer 56

**Rationale** b. OPA is a high-level disinfectant that has several advantages over glutaraldehyde. OPA does not require activation, does not irritate the eyes and nose, has very good stability, and has better mycobactericidal activity. One disadvantage of OPA over glutaraldehyde, though, is that OPA can stain skin and clothing.

Answer 57

**Rationale** d. To reduce the risk of bias, controls should be selected that are representative of the population being studied. The control group for this example includes patients with bacteremia but minimizes the number of patients with clinical sepsis.

Answer 58

**Rationale** a. The Centers for Disease Control and Prevention (CDC) Guidelines for Environmental Infection Control in Healthcare Facilities recommend that, during construction programs, facilities “create and maintain negative air pressure in work zones adjacent to patient care areas and ensure that required engineering controls are maintained.”

Answer 59

**Rationale** c. Cleaning is the first step in the reprocessing of endoscopies. Rinse and disinfect come later. Water soak is not an acceptable component of endoscope reprocessing. Active cleaning methods are needed.

Answer 60

**Rationale** d. As an infection prevention and control (IPC) subject-matter expert, the IP is responsible for evaluating cleaning and disinfection policies, procedures, and practices. The other options listed are primarily responsibilities of the EVS department, though the IP may be asked to advise on them.

Answer 61

**Rationale** a. The post-exposure and rapid response decision-making processes outline the decision tree or algorithm for assessing exposures and associated interventions.

Answer 62

**Rationale** b. Organizational leadership is responsible for ensuring that IPC programs (IPCPs) are adequately resourced. Risk management does not have decision-making rights to increase staffing and neither does the IP. Discussing this concern with colleagues and managers does not result in approval of additional staffing.

Answer 63

**Rationale** d. Evidence‐based practices are implemented through a variety of patient‐safety tools, but checklists and bundles remain two of the best ways to reduce infection rates and boost compliance among healthcare personnel (HCP), which leads to better patient outcomes.

Answer 64

**Rationale** d. External public health contacts should be notified first because the public health department is best suited to assist with potential cluster outbreak management; they can also provide health education regarding the disease processes involved to help prevent further transmission.

Answer 65

**Rationale** d. Positively pressurized rooms are usually designed to protect a patient, clean supplies, or equipment within the room. Trauma and delivery rooms are examples of rooms in hospitals and outpatient facilities that should be positively pressurized with respect to adjacent areas.

Answer 66

**Rationale** c. The prevention of SSIs consists of minimizing the contact of bacteria with the surgical site, neutralizing those bacterial species that do gain access to the wound, reducing adjuvant effects that create a local environment conducive to infection, optimizing the efficiency of host responses to potential pathogens, properly overseeing the environment of care, and managing instruments. The use of antimicrobial agents—such as ointments, solutions, or powders—on surgical incisions is, however, not recommended as a prophylaxis.

Answer 67

**Rationale** a. When a patient is suspected of having monkeypox, the IP should make sure appropriate isolation precautions are in place and maintained. Testing for monkeypox is performed by polymerase chain reaction (PCR) testing or next-generation sequencing of a clinical specimen.

Answer 68

**Rationale** d. OSHA’s Respiratory Protection Standard requires that facilities disallow workers from wearing an N95 respirator when an airtight seal between the respirator and the skin cannot be achieved.

Answer 69

**Rationale** d. Passive surveillance relies on those who are not specifically trained in or responsible for surveillance (e.g., healthcare providers and nurses) but who still report healthcare-associated infections (HAIs) to the IP.

Answer 70

**Rationale** c. When an air handler is shut off to an area, dust settles; and so, when the air handler is turned back on, that dust can disperse to other area—causing contamination—unless the area is properly cleaned while the air handler is off, before turning it back on.

Answer 71

**Rationale** a. Collecting flash sterilization data and reporting it quarterly allows the IP to analyze data over time to determine if performance improvement activities are effective.

Answer 72

**Rationale** b. The IP may end up recommending that additional instrumentation be purchased, and validating manufacturer’s IFU and ensuring that IUSS cycles documentation is complete are both important; however, the IP must first assess the current IUSS rate before they can create plans and objectives for improvement.

Answer 73

**Rationale** c. Checklists can be easily created to help audit processes within an organization. Understanding how processes are conducted can help generate helpful information for improvement.

Answer 74

**Rationale** a. The exposure control plan is the foundation for all activities related to possible exposure; it addresses employee training and confidentiality of records.

Answer 75

**Rationale** b. According to the Spaulding classification, the catheter is a critical piece of equipment because it enters a sterile body site. An artery is not a mucous membrane or non-intact skin, for both of which semi-critical equipment is used. Noncritical items only contact intact skin. Disposable equipment is not a level withing the Spaulding classification system.

Answer 76

**Rationale** a. Validity refers to how accurately a method measures what it is intended to measure. Criterion validity (or criterion-related validity) evaluates how accurately a test measures the outcome it was designed to measure—in this case, does the tool accurately measure the attitudes of staff towards IPC? Face validity refers to whether a scale “appears” to measure what it is supposed to measure. It is the least rigorous method for documenting a test’s validity. Construct validity is the extent to which a measurement tool is truly assessing what it has been designed to assess. Content validity refers to whether a test or scale is measuring all of the components of a given construct.

Answer 77

**Rationale** b. The need to contain infectious individuals and quarantine those exposed to disease has led to changes in public health laws and regulatory recommendations, as well as an increased leadership role for public health organizations across the globe. Additionally, the increasing prevalence of an all-hazards approach to emergency preparedness has led to growing alliances between emergency preparedness services, healthcare facilities, and community businesses. Importantly, public health organizations can provide the infrastructure and legal authority that healthcare facilities need to gain the cooperation of the general public to halt or slow the transmission of (and mitigate outcomes associated with) disease in the community at-large.

Answer 78

**Rationale** d. Before risk can be mitigated, an assessment of the impacted patient population as well as the level of risk must be determined—this is known as an ICRA, and it is used to assess and define controls for reducing risk during construction and renovation activities. The other options may form part of an ICRA, but they are too narrowly defined.

Answer 79

**Rationale** a. *Corynebacterium diphtheriae* is a true pathogen—that is, one that is able to cause infection and illness even in individuals with fully functioning immune systems.

Answer 80

**Rationale** a. Patients identified as potentially infectious should be immediately isolated according to the CDC’s “Identify, Isolate, and Inform” framework.

Answer 81

**Rationale** d. Retrospective data collection involves the collating of data that have already been collected, with a focus on examining what has already happened. Concurrent surveillance must be used to monitor construction projects and cleaning processes. Data may be recorded on spreadsheets for later review; however, inter-rater reliability is important for valid data.

Answer 82

**Rationale** b. Incident reporting should be voluntary and confidential and it should cover all adverse, sentinel, and near-miss events. The focus should be on how events occur, while underscoring individual accountability and responsibility.

Answer 83

**Rationale** a. Gram staining is fundamental to the phenotypic characterization of bacteria. The staining procedure differentiates organisms of the domain Bacteria according to their cell wall structures. Gram-positive cells have a thick peptidoglycan layer and stain blue to purple. Gram-negative cells have a thin peptidoglycan layer and stain red to pink.

Answer 84

**Rationale** d. Unless conflicting with local laws, regulations, or medical guidance, manufacturer’s IFU should always be followed for best IPC results and to extend the useful life of equipment.

Answer 85

**Rationale** a. An extraction area is where excess water is removed from textiles after laundering but before conditioning or drying. A folding area is where textiles are folded. A receiving area is where soiled textiles are sorted, usually by textile category and sometimes by degree of soiling or color. A conditioning and drying area is where, after extraction, textiles are either conditioned (partly dried) or fully dried in a dryer or tumbler.

Answer 86

Rationale a. One of the first tasks in an outbreak investigation is to verify that a cluster of cases is indeed an outbreak. Some clusters turn out to be true outbreaks with a common cause, others are sporadic and unrelated cases of the same disease, and still others are unrelated cases of similar but unrelated diseases. Early in the investigation process, the IP should look for additional cases to determine the true geographic extent of the problem and the populations it impacts.

Answer 87

**Rationale** c. *Presenteeism* is the term used for workers reporting to work when ill or contagious to others—often because workers fear losing income when taking days off. Because norovirus symptoms are usually self-reported, can be mild, and require two days off while asymptomatic, workers may be incentivized to report to work while still contagious. A facility can reduce presenteeism by reducing the incentive to come to work ill, such as by allowing workers to complete tasks from home.

Answer 88

**Rationale** b. The visual monitoring of processes established for construction, renovation, or maintenance procedures is an important method for reducing the potential for infection from airborne contamination.

Answer 89

Rationale d. All watches, rings, bracelets, and other hand jewelry (including wedding bands) should be removed before beginning antisepsis. Artificial fingernails or nail extenders must not be worn by any personnel in the OR. Staff should remove any debris from under fingernails using a nail cleaner under running water prior to the first scrub of the day. HH should be performed with soap or a hand sanitizer with persistent antimicrobial activity according to the manufacturer’s IFU; when using an ABHS, hands and forearms should be prewashed with a non-antimicrobial soap and then dried completely before applying the ABHS.

Answer 90

**Rationale** b. Vaccines should be protected from light and stored at recommended temperatures. In general, influenza vaccines should be refrigerated at temperatures between 36 and 46°F (2–8°C) and should never be frozen; vaccines that have been frozen should be discarded, and action should be taken if temperatures are out of range.

Answer 91

**Rationale** b. While performing a risk assessment, it is important that the IP critically appraise relevant literature, especially when there are competing priorities and inconsistent conclusions to the question at hand. Peer-reviewed journal articles are preferable to other publications; randomized clinical trials have greater strength than less rigidly controlled studies. And cost cannot be the primary motivating factor in making infection prevention and control (IPC) decisions.

Answer 92

Rationale d. EVS staff should be cleaning from top to bottom—that is, from high to low surfaces. Cleaning in this manner will help to prevent cross-contamination of already cleaned areas. Floors should, therefore, be cleaned last. Cleaning should also proceed from the cleanest to the dirtiest area, with the bathroom floor being the very last place cleaned.

Answer 93

**Rationale** a. An opportunistic infection does not usually cause disease in healthy people but may become pathogenic in immunocompromised individuals. The IP should be concerned about immunocompromising factors such as human immunodeficiency virus (HIV) status or other host defects that impair the immune system.

Answer 94

**Rationale** a. One of an IP’s roles is managing the physical environment to protect patients and workers. Workers should only use the respiratory protection type they are fit tested for.

Answer 95

**Rationale** d. A SWOT analysis can be used drive change by assessing organizational data though the identification of strengths, weaknesses, opportunities, and threats. DMAIC, PDSA and RCA are also QAPI tools, but DMAIC and PDSA focus on process or data-driven activities, while RCA is used to identify factors that contribute to adverse events. As such, a SWOT analysis is best suited to analyzing a pandemic preparedness program.

Answer 96

**Rationale** b. For each sterilization cycle, the sterile processing staff should document the following in the sterilizer records: * Lot number, date, and time * Contents of the load, including quantity, department, and a specific description of the items * Exposure time and temperature * Operator’s name or initials * Results of biological indicator (BI) testing and Bowie–Dick testing, if applicable * Response of the CI placed in the PCD * Any reports of inconclusive or nonresponsive CIs found later in the load * Aeration information (for ethylene oxide [EO]-processed loads)

Answer 97

**Rationale** a. An increased number of neutrophils in a white cell count typically indicates a bacterial infection. In an acute phase, immature neutrophils, called bands, can be present. Because patient in this example has a severe headache and an indication of a bacterial infection, there would be a concern that the patient may have a meningococcal infection. Meningococcal infection requires immediate antibiotic treatment.

Answer 98

**Rationale** b. Chlorhexidine is known for its persistent residual activity.

Answer 99

**Rationale** d. Policies and procedures should be reviewed at least annually and revised as needed (for example, when services or products change or a new outbreak occurs). This ongoing review process should be documented because review process documentation is routinely inspected during facility surveys. If a healthcare facility does not perform this review on time, it may be receive a citation from regulatory or accreditation review bodies.

Answer 100

**Rationale** b. Antibiotics are a kind of antimicrobial synthesized by living organisms to kill microorganisms. Antiseptics are not synthesized by living organisms and are used to treat minor conditions. Suppressants are substances that restrain or suppress something. Supplements are products used to complete a deficiency.

Answer 101

**Rationale** d. RCA is a process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event. An RCA focuses on systems and processes, not on individual performance. An RCA identifies potential improvements that may decrease the likelihood of such events in the future; it may also determines, after analysis, that no such improvement opportunities exist.

Answer 102

**Rationale** d. While recreational drug use, proximity, and underlying conditions all play their roles in disease transmission, they are not exclusively features of homelessness. The lack of availability of basic hygiene is, however, consistent among those experiencing homelessness.

Answer 103

**Rationale** a. Healthcare providers and facilities have a legal duty to care for their patients. A breach of duty is any deviation from recognized standards of care.

Answer 104

**Rationale** d. FMEA is a systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures in order to identify the parts of the process that need change.

Answer 105

**Rationale** a. In simple terms, an outbreak is 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 expected outcome.

Answer 106

**Rationale** d. There is no requirement that facilities have a licensed food-service or registered EVS program. While it is expected that efforts will be made to prevent HAIs, a reduction in their numbers is not a regulatory requirement. A QAPI component that addresses systems of care, quality of life, and outcomes of care is often a regulatory requirement.

Answer 107

**Rationale** b. While all of the above information may be important to communicate to a post-acute facility, the most important thing to communicate to facilitate proper placement and isolation management is the fact that the patient is positive for *Candida auris. C. auris* is a multiple-drug-resistant organism (MDRO) that requires contact precautions and is more common in patients who have been hospitalized in a healthcare facility for a long time, have a central venous catheter (CVC) or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications.

Answer 108

**Rationale** c. Glutaraldehyde is a respiratory irritant. Healthcare personnel (HCP) may be exposed to elevated levels of glutaraldehyde vapor when equipment is processed in poorly ventilated rooms, when spills occur, when glutaraldehyde solutions are activated or changed, or when open immersion baths are used. Acute or chronic exposure can result in skin irritation or dermatitis, mucous membrane irritation (eye, nose, mouth), or pulmonary symptoms.

Answer 109

**Rationale** c. Ensuring product efficacy for low-level disinfection is the most important consideration. Because the product will be used on medical equipment (and not staff or other persons), product odor and HCP preferences are less important than product efficacy.

Answer 110

**Rationale** d. Data for benchmarks and comparison with other similar facilities (e.g., data from the National Healthcare Safety Network [NHSN]) must follow specific definitions and algorithms exactly to be valid.

Answer 111

**Rationale** a. Many prevention efforts are targeted to specific populations or subpopulations. As such, the IP must have an understanding of the needs of the population to be served.

Answer 112

**Rationale** b. By first identifying patients who require isolation precautions, the IP can determine the next steps in their evacuation response.

Answer 113

**Rationale** d. All of the above infectious agents can cause meningitis; however, *Listeria monocytogenes* has been found in uncooked meats, uncooked vegetables, unpasteurized milk, foods made from unpasteurized milk, and processed foods. Pregnant women are more likely to contract *Listeria spp*. Listeriosis is 18 times more common in pregnant women than in the non-pregnant population. 16 to 27 percent of all *Listeria* infections occur in pregnant women.

Answer 114

**Rationale** b. Case-control studies start with the knowledge of who does and does not have the illness. The other types of study designs would not be useful with such a relatively small sample size.

Answer 115

**Rationale** d. Only the VRE CI excludes the null hypothesis value (risk ratio = 1). The infection rate reduction was significant only for VRE.

Answer 116

Rationale a. All Gram stains are scanned for the presence or absence of WBCs (indicative of infection) and squamous epithelial cells (indicative of mucosal contamination) that give information about the specimen quality. A sputum specimen showing more than 10 squamous epithelial cells per low-power field, regardless of the number of WBCs, is indicative that the specimen is grossly contaminated with saliva and the culture results cannot be properly interpreted. The presence of fewer than 10 squamous epithelial cells per low-power field indicates that true lower respiratory tract secretions have been collected.

Answer 117

**Rationale** c. While HH practice and cultural sensitivity are important, due to the type of clinic (diabetes) and educational needs of staff (glucometer use), the IP should train staff on the importance of safe injection practices—e.g., single-use fingerstick devices and single-patient insulin pens—to promote safe work practices and prevent bloodborne pathogen (BBP) exposures.

Answer 118

**Rationale** d. The MIC is the lowest concentration of a chemical that prevents visible growth of a bacterium.

Answer 119

**Rationale** d. A risk assessment should include a comprehensive set of factors that will ensure the best patient outcomes for the population served.

Answer 120

**Rationale** b. The conjugation transfer of R plasmids, also termed “horizontal evolution,” is the most common method by which antibiotic resistance is acquired. In this method, the bacteria need not multiply to spread their plasmid. Instead, the plasmid is moved during conjugation. These plasmids often code for resistance to several antibiotics at once.

Answer 121

Rationale c. By the end of a surgical procedure, every surgical wound will have been contaminated with bacteria. The probability of those wounds becoming infected is determined by four clinical variables: 1) inoculum of bacteria, 2) virulence of the microorganism, 3) efficiency of host defenses, and 4) adjuvant effects of the microenvironment.

Answer 122

Rationale d. When the null hypothesis is false and the infection preventionist (IP) fails to reject it, they make a type II error. The probability of making a type II error is β, which depends on the power of the test. The IP can decrease their risk of committing a type II error by ensuring that their test has enough power. They can do this by making sure that the sample size is large enough to detect a practical difference when one truly exists.

Answer 123

**Rationale** b. A facility’s IPC risk assessment helps to define the purpose of surveillance and identify the events to be monitored and the data to be collected—all of which information is need to create a surveillance plan.

Answer 124

**Rationale** c. Commercial washers and dryers provide sufficient heat to kill organisms; as such, it is not necessary to move linen in-house, treat staff with a prophylaxis, or apply insecticides.

Answer 125

**Rationale** a. Concurrent data collection is performed in real time while a patient is receiving care within a healthcare facility.

Answer 126

**Rationale** d. Outcome measures indicate the results of a process—in this example, documentation of catheter care. Process measures are used to monitor program implementation (e.g., compliance with hand hygiene [HH]). Impact evaluations assess a program’s effect on participants. Appropriate measures include changes in awareness, knowledge, attitudes, behaviors, or skills. Content analysis is a research tool used to determine the presence of certain words, themes, or concepts within a qualitative data set.

CIC Certification Pre-test Flashcards

(150 cards)