Practice exam 1 Flashcards
1
Q
The bacterium most likely to be transmitted from mother to infant during labor and cause neonatal sepsis is:
a. Escherichia coli
b. Staphylococcus aureus
c. Group B Streptococcus
d. Group A Streptococcus
A
Group B Streptococcus
Heavy maternal colonization is associated with an increased risk for preterm labor, which in turn is a significant risk factor for neonatal infection. Intrauterine infection of the fetus therefore likely occurs via ascending spread of GBS from vagina of a pregnant, symptomatically colonized woman and subsequent rupture of membranes before 37 weeks’ gestation.
APIC Streptococci
2
Q
An IP is developing an education session related to sharp object injuries. She wants to target this session specifically to healthcare personnel at her facility.
What is the best way to prepare this session?
a. Gather data from occupational health reports on sharp object injuries in the facility.
b. Gather information on national data about sharp object injuries in HCP.
c. Hold forums in each unit to find out what HCP experiences have been with sharp object injuries.
d. Perform a literature search to research the topic of sharp object injuries in HCP
A
Gather data from occupational health reports on sharp object injuries in the facility.
HCP will be most persuaded by data that relate to them.
APIC Education and Training
3
Q
The primary functions of an Infection prevention and control program should include all except:
a. To develop and recommend policies and procedures related to infection prevention and control.
b. To conduct surveillance for healthcare-associated infections (HAIs).
c. To decrease the length of stay for patients.
d. To educate HCP and patients in infection prevention practices.
A
To decrease the length of stay for patients
The principal functions of an Infection prevention and control program includes:
Obtaining and managing critical data and information, by surveillance for infections.
Developing and recommending policies and procedures.
Intervening directly to prevent infections
Educating and training HCP, patients, and non-medical care givers.
APIC Infection Prevention and Control Program
4
Q
What type of meningitis would be most consistent with the following cerebrospinal fluid (CSF) report result:
- Glucose - decreased
- Protein - elevated
- WBC counts 1,00/mm 3
a. Bacterial
b. Viral
c. Fungal
d. Tuberculosis
A
Bacterial
Culture of blood and CSF are indicated for patients with suspected invasive meningococcal disease. The CSF of patients with untreated meningococcal meningitis is usually cloudy and has pleocytosis with a predominance of neutrophils, low glucose, and high protein levels. in most of the cases, the organisms are seen on Gram stain or can be identified using latex agglutination assays. The culture is almost invariably positive as long as the sample was obtained before the administration of antibiotics.
APIC Central Nervous System Infection
5
Q
The following blood culture result should be considered a potential contaminant:
a. A positive result of coagulase-negative staphylococci from two sets, 2 days apart, without symptoms.
b. A positive result of S. aureus from one bottle in a patient with a temperature of 38.6 C
c. A positive result of E.coli from one bottle in an afebrile patient with diarrhea.
d. A positive result on Candida albicans in a fungal blood culture in a patient with a urinary tract infection.
A
A positive result of coagulase-negative staphylococci from two sets, 2 days apart, without symptoms.
CDC CLABSI criteria, common commensals (such as coagulase-negative staph) meet the criteria for a CLABSI if there are two positive cultures from two or more sets of blood cultures drawn less than 2 days apart and the patient has symptoms ( fever greater than 38 C, chills or hypotension).
6
Q
Which of the following organisms have been associated with the transmission of infections after body piercing?
1) Atypical Mycobacterium species.
2) Staphylococcus species
3) Pseudomonas species
4. Haemophilus species
a. 1,2,3
b. 2,3,4
c. 1,3,4
d. 1,2,4
A
1,2,3
Atypical Mycobacterium species
Staphylococcus species
Pseudomonas species
Body piercing activities can transmit infectious disease. Bacterial infections may result from improper initial piercing technique or from poor hygiene.
APIC Body Piercing, tattoos and electrolysis
7
Q
The Director of the Operating room (OR) requests that the OR surfaces be routinely environmentally cultured. The IP’s best response should be:
a. A schedule for routine culturing of the OR should be arranged so that each room is cultured at a set interval.
b. Routine culturing of the OR should be done in the absence of any epidemiological investigations in that area.
c. Routine culturing should not be done because it is too expensive.
d. Routine environmental culturing should not be considered unless an epidemiological investigation is being conducted.
A
Routine environmental culturing should not be considered unless an epidemiological investigation is being conducted.
Microbial environmental testing is not generally recommended.
APIC Microbiology Basics
8
Q
All of the following may be indications of a heating, ventilation, and air conditioning (HVAC) malfunction except:
a. An increase in the postoperative surgical site infection (SSI) rates.
b. A single case of aspergillosis in a severely immunosuppressed patient.
c. Healthcare - associated varicella infections.
d. An outbreak of ventilator-associated Acinetobacter infections in the Intensive Care Unit (ICU).
A
An outbreak of ventilator-associated Acinetobacter infections in the Intensive Care Unit (ICU).
Detection and Identification of certain HAIs may suggest HVAC malfunction and are usually not the immediate cause of device-associated HAIs.
APIC - Heating, Ventilation, and Air Conditioning
9
Q
A patient who underwent intraocular surgery was diagnosed with a noninfectious endopthalmitis after the procedure. The IP initiates an investigation to identify the possible cause. Which of the following factors should be considered?
1) Improper handling, cleaning and rinsing of the instruments.
2) Improper labeling of the solutions
3) Gloves and powder
4) Prophylactic antibiotics administered 2 hours before the procedure.
a. 1,3 b. 1,2 c. 3,4 d. 2,4
A
Improper handling, cleaning and rinsing of the instruments.
Gloves and powder
Endophtalmiitis is an inflammatory condition of the intraocular cavities usually caused by infection. Noninfectious endophthalmitis may result from various causes such as retained native lens material after an operation or from toxic agents. Improper cleaning and rinsing of surgical instruments can leave a residue, which can irritate the eye and cause inflammation of the eye during surgery
APIC Ophthalmology Services
10
Q
Sensitivity may be defined as:
a. The ability of a test to detect true positive (person with the disease) when applied to a population with the disease.
b. The ability of a test to detect the true negatives (persons without the disease) when applied to a population without the disease.
c. The ability of a test to detect true positives (persons with disease) when applied to a population without the disease.
d. The percentage of persons with true positive results when the test is applied to persons without the disease.
A
The ability of a test to detect true positive (person with the disease) when applied to a population with the disease.
Sensitivity and specificity are common statistical measures to describe diagnostic tests or presence of disease. Sensitivity is the ability of a test to identify true cases or persons who have the disease or health condition of interest. In other words, it is the probability of getting positive test results among patients with disease. A high sensitivity test means that a negative result rules our the disease.
APIC Use of Statistics in Infection Prevention
11
Q
The IP is monitoring blood work in order to differentiate between bacterial or viral infection in a newly admitted ICU patient. Which of the following components of a complete blood count (CBC) should the IP examine in order to determine this information?
a. Hematocrit
b. Whit blood cell count
c. Platelet (thrombocyte count)
d. Red blood cell indices
A
White blood cell count
A WBC count and differential provide information about the relative numbers of each type of WBC. Evaluation of WBC count can help to determine whether an illness has a bacterial or viral origin.
12
Q
A nurse manager from a Rehabilitation Unit is requesting that aerators be installed on the sinks in the patients rooms on her unit. The IP should explain that:
a. Aerators should be placed on all sinks in the ICU only
b. Aerators are more effective when combined with an ultraviolet water disinfection method.
c. Aerators increase the risk of HAIs
d. Low-flow aerators are suitable for use with this population.
A
Aerators increase the risk of HAIs
Various types of equipment and fixtures can promote the growth of water-associated pathogens. Important water reservoirs for these organisms include potable water systems and cooling towers, flush sinks, faucet aerators, hoppers and toilets, eyewash/drench shower stations, chests /ice machines, water baths used to thaw or warm blood products and other liquids, and whirlpool or spa-like baths. Aerators are not recommended.
APIC Water systems issues and prevention of waterborne infectious diseases in Healthcare Facilities.
13
Q
Herpes simplex virus (HSV) keratitis is suspected in an oncology patient. Aerobic eye cultures are negative to date. A single serum sample is sent for enzyme - linked immunosorbent assay (ELISA) antibody testing. The following titers are reported: HSV titer 1:128, cytomegalovirus (CMV) titer <1:8, Epstein-barr (EBC) titer< 1:*, these results indicate:
a. Immunity to HSV
b. Confirmation of acute HSV infection
c. Presumptive identification of HSV infection
d. Immunity to CMV and EBV
A
Presumptive identification of HSV infection
APIC Herpes Virus
14
Q
The Nursing Supervisor calls the IP at home to inform him that a patient has presented to the ED with a fever and rash and has been diagnosed with measles. The IP’s first action should be:
a. Place the patient in Airborne Precautions
b. Contact the local public
c. Place the patient in Airborne and Contact Precautions
d. Check the immunization status of the ED staff
A
Place the patient in Airborne Precautions
Measles are transmitted by direct contact with infectious droplets. In addition to Standard precautions, Airborne Precautions are indicated in healthy patients for 4 days after the onset of rash. If the patient is immunocompromised, he or she must remain on precautions for the duration of illness.
15
Q
A patient is admitted for a skin infection after swimming in the ocean. Which of the following organisms is the most likely cause?
A. Mycobacterium marinum
B. Mycobacterium avium
C. Mycobacterium leprae
D. Mycobacterium tuberculosis
A
Mycobacterium marinum
This organism causes cutaneous lesions after exposure to swimming pools, fish tanks, or other water sources. The organism may enter through previously unappreciated superficial nicks and abrasions. The lesions first appear as papules and later ulcerate. Because special culture conditions must be used to isolate the organism, the lab should be alerted if this is a diagnostic consideration.
APIC Tuberculosis and Other Mycobacteria
16
Q
An ambulatory clinic will be transporting equipment to the local hospital for sterilization. The IP at the clinic has been asked to write a policy to ensure safe handling of the equipment by staff. The policy should include which of the following points on handling the instruments at the point of use?
1) Devices are to be cleaned before biofilm can form
2) Keep instrumentation moist to prevent bio burden from drying
3) Instruments with lumens should be flushed with saline
4) Contaminated devices are to be placed in a sealed container to prevent exposure to staff and patients.
A. 1,3,4. B. 2,3,4. C. 1,2,4. D. 1,2,3
A
Devices are to be cleaned before biofilm can form
keep instrumentation moist to prevent bio burden from drying
Contaminated devices are to be placed in a sealed container to prevent exposure to staff and patients.
17
Q
What is the probability of committing a type 1 error if the p value is 0.10?
A. 1 in 10
B. 1 in 100
C. 1 in 5
D. 1 in 20
A
1 in 10
APIC use of Statistics in Infection Prevetion
18
Q
Which of the following is an example of the principle of emergency management called “mitigation?”
a. Implementation of the hospital’s emergency management plan during a hurricane.
b. Recovery efforts after a major flood has subsided.
c. A facility-wide bio-terrorism disaster drill.
d. Funding a program that will provide ring vaccination of exposed people against smallpox during an outbreak.
A
Funding a program that will provide ring vaccination of exposed people against smallpox during an outbreak.
Disasters should be planned for and responded to using the principles of emergency management.
APIC Emergency Management
19
Q
The purpose of the antibiogram is to:
a. Provide a monthly report on new and emerging antimicrobials.
b. Give IPs another metric to track
c. Provide information on antimicrobial usage and resistance patterns in the community.
d. Give hospitals information needed for reporting data through the National Healthcare Safety Network (NHSN)
A
Provide information on antimicrobial usage and resistance patterns in the community.
APIC Antimicrobials and Resistance
20
Q
The most common organism associated with pneumonia in school-aged children and young adults is:
a. Neisseria meningitidis
b. Streptococcus pneumoniae
c. Staphylococcus aureus
d. Mycoplasma pneumoniae
A
Mycoplasma pneumoniae
Mycoplasma is uncommon under the age of 5 but is the leading cause of pneumonia in school-aged children and young adults. It can occur during any season and occurs throughout the world.
21
Q
The purpose of a root cause analysis is to:
a. Determine which individual made an error so that the employee may be disciplined or terminated.
b. Review the basic processes that are in place and then turn that review over to a unit-specific team so that they can determine how they should modify their practices.
c. Provide a process that requires little time or training but allows employees to identify culpability after an adverse event.
d. Include participants from diverse areas of the organization to delve into the cause of an error or systems failure and identify changes in practice and /or policy that will prevent a repeat of that error or event.
A
Include participants from diverse areas of the organization to delve into the cause of an error or systems failure and identify changes in practice and /or policy that will prevent a repeat of that error or event.
APIC Quality Concepts
22
Q
A pediatrics patient has been diagnosed with pediculosis. What is the most appropriate follow-up to prevent it from spreading to other patients or HCP?
a. Place the patient on Contact Precautions until 24 hours after appropriate treatment has been initiated.
b. Require all visitors and HCP who enter the room to wear a disposable scrub cap for any patient contact.
c. Use an insecticidal spray in the room after the patent is discharged.
d. Prophylactically treat all family members and anyone with close physical contact with the patient.
A
Place the patient on Contact Precautions until 24 hours after appropriate treatment has been initiated.
In addition to placing the patient on Contact precautions, patient bedding,clothing, and waterproof personal items should be washed at high temperature.
APIC Viral Hemorrhagic Fevers
23
Q
An employee has experienced an accidental needle stick injury while providing care to a patient. All of the following lab test would be appropriate for the source patient except:
a. Human immunodeficiency virus (HIV)
b. Hepatitis B antibody
c. Hepatitis B surface antigen
d. Hepatitis C surface antigen
A
Hepatitis B antibody
A positive Hepatitis B antibody indicates past infection or immunity via vaccination. It does not indicate active infection.
APIC Occupational Exposure to Blood-borne pathogens.
24
Q
The IP receives a call from a physician who is concerned that there is an outbreak of Acinetobacter baumannii, because he has cared for four patients in the past week who are infected with the organism. What is the IP’s first step in responding to this call?
a. Contact the lab to ask them to create an alert for any A. baumannii cases.
b. Contact hospital administration to request additional resources to investigate the outbreak.
c. Confirm that there is an outbreak by using her own surveillance data and lab records to compare the rates of Acinetobacter baumannii over the past year.
d. Initiate a case-control study to determine risk factors for A. baumannii infection.
A
Confirm that there is an outbreak by using her own surveillance data and lab records to compare the rates of Acinetobacter baumannii over the past year.
Confirming the presence of an outbreak is a key first step in an outbreak investigation
APIC Outbreak investigation
25
The IP receives a call from the Food and Drug Administration (FDA) with an official request for private health information (PHI) about a patient who was admitted to the facility with botulism. How should the IP respond to this call?
a. Tell the FDA officer that she cannot share PHI with the FDA due to Health Insurance Portability and Accountability Act (HIPAA) regulations.
b. Ask the FDA to contact the local health department to obtain information about the patient.
c. Provide the FDA officer with the minimum amount of information necessary related to the patient.
d. Transfer the call to the Risk Management Department.
Provide the FDA officer with the minimum amount of information necessary related to the patient.
The FDA is a public health authority. HIPAA regulations cover disclosure to the FDA of the minimum amount of information is necessary to prevent of control disease.
APIC - Legal Issues
26
A measles exposure from a patient in a clinic was identified and an exposure workup was initiated. A staff exposure was defined as "non-immune HCP with more than 5 minutes of same-room contact or face-to-face contact with the index patient." Forty-eight HCP were identified as possible exposures. Of these, 44 had documented immunity to measles. Of the remaining HCP, three did to have the same room or fact-to-face contact. How many HCP were at risk of developing measles because of this exposure?
a. 4
b. 45
c. 1
d. 48
1
Measles is highly contagious febrile exanthem. According to the definition of staff exposure, only one healthcare worker was non-immune and had more than 5 minutes of same-room contact or face-to-face contact with the index patient. This HCP must be furloughed from the 5th to the 21st day after exposure, regardless of whether they had vaccines.
APIC Measles, mumps, rubella
27
A nurse working in the recovery room is pregnant and has told her manager that she cannot take care of patients with methicillin-resistant S. aureus (MRSA). The manager contacts the IP for a recommendation. The best response is to:
a. Tell the manager that the nurse will need to be assigned to patients without multi-drug - resistant organisms (MDROs) for the duration of her pregnancy.
b. Meet with the nurse and reassure her that she is at no greater risk of contracting MDROs as long as she practices Standard Precautions.
c. Contact the nurse's healthcare provider and explain why he/she gave the wrong advice.
d. Agree with the nurse and ask the manger to put her on light duty.
Meet with the nurse and reassure her that she is at no greater risk of contracting MDROs as long as she practices Standard Precautions.
For practical purposes, immunologic function is normal during pregnancy, and an otherwise healthy woman is not considered to be an immunocompromised host. Pregnancy does not increase the risk of acquisition of infections, and for most infectious agents, clinical manifestations of infections are no more severe in pregnant women than in those who are not pregnant. As long as proper infection control practices are used, pregnant HCP are at no greater risk than non-pregnant HCP.
APIC Pregnant Healthcare Presonnel
28
Vaginal probes with probe covers require which type of disinfection:
a. Low-level disinfection
b. Intermediate-level disinfection
c. High-level disinfection
d. Sterilization
High-level disinfection
Vaginal probes are used in sonographic scanning. A vaginal probe and all endocavitary probes without a probe cover are semi-critical devices because they have direct contact with mucous membranes. It is recommended that a new probe cover should be used for each patient. These covers may fail or be compromised a high-level disinfection of the probe should also be performed.
APIC Cleaning, Disinfection, and sterilization
29
The IP is reviewing the facility's performance measures, which are used to benchmark against national data. The IP ensures that each performance measure includes which of the following characteristics?
1) . Measure is reliable
2) . Measure targets improvement in a health population.
3) . Measure is defined according to physician preference
4) Measure can be easily interpreted by the users of the data.
a. 1,2,3 b. 1,2,4 c. 2,3,4 d. 1,3,4
Measure is reliable
Measure targets improvement in a health population.
Measure can be easily interpreted by the users of the data.
Performance measures focus on outcomes or processes.
APIC Performance Measures
30
A preliminary microbiology report states that a patient's blood culture grew aerobic, gram-negative bacilli. Which of the following is the most likely genus and species of the organism?
a. Enterococcus faecalis
b. Bacterioides fragilis
c. Acinetobacter baumanii
d. Neisseria Meningitides
Acinetobacter baumanii
Acinetobacter baumannii is a gram-negative bacterium. It is typically short, almost round, and rod-shaped (coccobacillus). It can be an opportunistic pathogen in humans, affecting people with compromised immune systems and is becoming increasingly important as an HAI. It has also been isolated from soil and water samples in the environment.
APIC Environmental Gram-negative Bacilli
31
Urinary tract infections in the postpartum period have three important risk factors. Which of the following is NOT one of them?
a. Induction of labor
b. Tocolysis
c. Cesarean delivery
d. Twin births
Twin births
UTIs in the postpartum period have three important risk factors: cesarean delivery, tocolysis, and induction of labor. Twin births are NOT associated with an increased risk of UTI.
APIC Urinary tract infection
32
If chance is likely the explanation for the difference between a sample statistic and the corresponding null hypothesis population value, then:
a. The difference is not statistically significant.
b. The sample results are not compatible with the null hypothesis
c. The difference is statistically significant
d. the null hypothesis can be rejected.
The difference is not statistically significant.
A common use of statistics is hypothesis testing. A hypothesis is a statement of expected results. Hypothesis testing uses the distribution of a known area in the normal curve and estimates the likelihood that a result did not occur by chance.
APIC use of Statistics
33
Non-infectious postoperative endophthalmitis is most often associated with:
a. Wearing contact lens
b. Toxic anterior segment syndrome (TASS)
c. Conjunctivitis
d. Keratitis
Toxic anterior segment syndrome (TASS)
Outbreaks of TASS have been associated with breaches in handling, cleaning, and disinfecting surgical instruments; introduction of contaminated solutions, contaminated intraocular lenses, and toxic medications during surgery; powder from gloves; and irritants (dried blood, endotoxins, residual detergent) left on instruments.
APIC Ophthalmology Services
34
An acute care facility experiences an outbreak of Serratia marcescens bloodstream infections. After the outbreak is under control and no new cases are being reported, the IP wants to find the source of the outbreak. The most appropriate epidemiology study design to use is:
a. Retrospective cohort study
b. Prospective cohort study
c. Case-control study
d. Cross-sectional study
Case-control study
Case-control studies group people by disease status and then investigate past exposures with the objective of identifying exposures that are more common to cases than to controls. This is an appropriate study design for this example because there are existing cases, and the IP is trying to identify the exposure that are associated with bloodstream infections.
APIC General Principles of Epidemiology and Research Study Design
35
To calculate the CAUTI rate for a unit for 1 month, the denominator should be:
a. The number of patient days for the unit for the month.
b. The number of admissions for the unit for the month
c. The number of patients with urinary catheters for the month
d. The number of urinary catheter insertions for the month
The number of patients with urinary catheters for the month
1. persons in the denominator must reflect the same population from which the numerator was taken.
2. Counts in the numerator and denominator should cover the same time period.
3. The persons in the denominator should have been at risk of the event or occurrence. (that is number of patients with urinary catheters)
APIC use of Statistics in Infection Prevention
36
Which of the following is an example of surveillance on a process indicator?
a. The incidence rate of Clostridium difficle in the Bone Marrow transplant Unit.
b. The rate of hand hygiene compliance in the Bone Marrow transplant Unit
c. The number of sharp object injuries in the month of May in the Bone Marrow Transplant Unit
d. The prevalence of vancomycin-resistant enterococci (VRE) in the Bone Marrow Transplant Unit
The rate of hand hygiene compliance int he Bone Marrow transplant Unit
This is a process measure because it is measuring whether an action has taken place but not whether there is any effect of this action on outcomes.
APIC Surveillance
37
The Director of Infection Prevention and Control has hired a novice IP who has a Master of Public Health degree and has worked in the Epidemiology Division of the local health department for 2 years. The IP's academic training included core courses in epidemiology, bio-statistics, behavioral science, health policy, and environmental health, and he was in charge of disease surveillance and outbreak control activities at the health department. Of the following, which will be the first priority in his orientation to Infection Prevention and Control?
a. Have him review the Control of Communicable Diseases Manual and evaluate his knowledge with a written quiz.
b. Have him visit the different clinical practice areas to meet with managers, and ask him to summarize the infection control needs of each manager.
c. Have him attend an online class on the use of statistical software package like Excel or Epi Info.
d. Have him read the APIC text cover-to-cover before taking part in any applied orientation activities.
Have him visit the different clinical practice areas to meet with managers, and ask him to summarize the infection control needs of each manager.
The most basic goal of healthcare education and training is to improve job skills and cometetnce. Needs assessments will identify deficiencies in knowledge, skills, or attitude and serve as the basis for training. Given the lack of experience at a healthcare facility, the new IP should meet the different managers and gain an understanding of how each area relates to and interacts with the IP team.
APIC Education and Training; Competency and Certification of the IP
38
What is the range for the following numbers: 2,3,5,8,9,10,11,15,18.
a. 16
b. 18
c. 9
d. 2
16
The range provides a value that represents the difference between the highest and lowest values in a data set. Like the mode in the measures of central tendency, the range is the least number and lowest number is this data set is 18-2 = 16.
39
An IP has been asked to evaluate a new antimicrobial-impregnated dressing in order to reduce device-associated infections. The initial step in the product evaluation process is to establish whether:
a. The new product is cost effective
b. The product is safe
c. There is a need for the new product
d. The impact on clinical outcomes is positive
There is a need for the new product
A product evaluation process should always begin with the identification of a need.
APIC Product Evaluation
40
After reviewing the quarterly report, the manager of the adult ICU contacts the IP for assistance to create a plan to reduce central line infections. Which of the following should the IP recommend:
a. Wait for the next report to see if the rate has decreased.
b. Create an Intravascular Team
c. Develop a multidisciplinary team to review and implement best practices.
d. Send a referral to Medical Affairs for peer review
Develop a multidisciplinary team to review and implement best practices.
Multidisciplinary teams are a valuable tool in deploying a quality-focused culture or process.
APIC Quality Concepts
41
Important considerations regarding blood culture specimens include:
1) Collect prior to the initiation of antimicrobial therapy
2) Collect from a central venous catheter whenever possible
3) Ensure that the volume of the specimen collected is sufficient
4) Culture of specific sites is not recommended for surveillance
a. 1,3
b. 2,4
c. 1,4
d. 3,4
Collect prior to the initiation of antimicrobial therapy
Ensure that the volume of the specimen collected is sufficient
The accuracy of a blood culture can be impacted by a wide variety of factors, many of which pertain to skin antisepsis and/or specimen collection techniques.
APIC Microbiology Basics; Blood Cultures
42
An IP subscribes to several peer-reviewed journals. As she reviews published articles describing research findings, what question should she ask before incorporating the conclusions/findings of the article into the infection prevention program?
a. Was the appropriate study design used and are the conclusions reasonable?
b. Is the author well known and well published?
c. Does the article state how to contact the author(s) with questions?
d. Are the findings described in tables or graphs and easily understandable?
Was the appropriate study design used and are the conclusions reasonable?
Many study designs, observational or experimental, are available to investigators. Understanding the advantages and disadvantages of each study design should prepare the IP to critically evaluate published research studies so as to appropriately assign value to the findings.
APIC Research Study Design
43
A patient with suspected active tuberculosis has been admitted to an acute care facility. To date, two sputum samples have been tested for acid-fast bacilli (AFB) and both were negative. What type of isolation Precautions are now indicated for the patient?
a. Standard Precautions
b. Contact Precautions
c. Airborne Precautions
d. Droplet Precautions
Airborne Precautions
The patient should remain on Airborne Precautions until three sputum samples are AFB negative.
APIC Tuberculosis and Other Mycobacteria.
APIC Isolation Precautions
44
Which of the following scenarios would be most appropriate for immediate-use sterilization:
a. The vendor brings the instrument for the procedure with morning of the surgery, which does not allow for the full sterilization process.
b. The instrument used for the procedure is dropped on the floor of the operating room and another instrument is not available.
c. The turnaround time between procedures does not allow enough time for the full sterilization process.
d. The OR does not have the needed instruments to meet the demand of surgeries; therefore, the instruments are flashed between procedures.
The instrument used for the procedure is dropped on the floor of the operating room and another instrument is not available.
Flash sterilization is a quick-steam sterilization cycle that does not use the full sterilization cycle of exposure and dry times.
Chapter 68 - Surgical Services
45
The Director of the Infection Prevention and Control Department has assigned one of her IPs to co-facilitate in a root cause analysis of an adverse event in collaboration with the Performance Improvement team. The IP plans to use process improvement tolls and techniques during the analysis. Which of the following methods would best outline the possible causes the event?
a. Brainstorming
b. Affinity diagrams
c. Fish-bone diagram
d. Pareto chart
Fish-bone diagram
A fish-bone diagram (also called a tree diagram or Ishikawa) allows a team to identify, explore, and graphically display all of the possible causes related to a problem to discover the root cause.
APIC Quality Concepts
46
Which of the following is not an infection prevention objective of an occupational health program?
a. Contain costs to personnel for work-related illnesses or exposures.
b. Provide care to personnel for work-related illnesses or exposures.
c. Educate patients about the principles of infection prevention.
d. Collaborate with the Infection Prevention Department in monitoring and investigating potentially harmful infectious exposures and outbreaks.
Educate patients about the principles of infection prevention.
The healthcare organization's administration, medical staff, and other HCP need to support the infection prevention objectives of an occupational health program.
APIC Occupational Health
47
An IP is presenting data on the rate of central line-associated bloodstream infections (CLABSI) in the ICU for the last month. Which graphic display is the most appropriate choice for this data?
a. A bar chart
b. An ogive
c. A frequency polygon
d. A frequency histogram
A bar chart
A bar chart is the best choice for displaying this data because this is discrete data that is mutually exclusive.
APIC Use of statistics in Infection Prevention
48
What action is indicated when the IP is asked to help determine if a worker has experienced occupational acquisition of an infectious agent or disease in order to receive worker's compensation benefits?
a. Provide enough information to prove or disprove the employee's claim.
b. Notify the facility's attorney immediately
c. Review the worker's compensation system in place
d. Perform a root cause analysis to investigate
Review the worker's compensation system in place
Disease that results from occupational exposure usually is eligible for compensation if the occupational exposure is the sole cause of the disease; the occupational exposure aggravates a pre-existing disease; or the occupational exposure hastens the onset of disability. The burden of proving that disease was occupationally acquired lies with the workers. The IP's expertise may be needed to help assess this situation. Risk Management and Occupational Health proved the necessary follow-up. IPs shold be familiar with the workers' compensation system in place within their country.
APIC Employee/Occupational Health
49
The safe temperature range for cold food storage is:
a. 41 F/ 5 C or lower
b. 42 F /5.6 C to 10 C
c. 50 F / 10 C to 12.8 C
d. Less than 60 F / 15.6 C
41 F/ 5 C or lower
APIC Nutrition Services
50
A robust Performance Improvement team should perform all of the following EXCEPT:
a. Observational audits
b. Benchmark comparisons
c. Root cause analyses
d. House wide infection rates
House wide infection rates
A robust performance improvement program should include the following basic elements; measuring how a facility or organization controls or complies with policies; documenting results of observational audits; performing root cause analyses; reporting individual physician or unit infection rates; and bench-marking the organization's infection rate against community, state, and national averages.
APIC Quality Concepts
51
Toys used for inpatient pediatric patients should ideally be all of the following EXCEPT:
a. new
b. nonporous
c. plush
d. single-patient use
plush
Implementation of a process for appropriate toy acquisition to ensure suitability for cleaning/disinfection; toys should be nonporous and able to withstand rigorous mechanical cleaning. Avoid toys that are water-retaining, plush, and stuffed (an exception is therapeutic dolls, which should be single-patient use); and those that are difficult to clean and dry.
APIC Pediatrics
52
Which of the following would be an appropriate method to evaluate the quality of an infection prevention program?
a. The total number of areas where surveillance was carried out in the past year.
b. The average amount of time that elapsed between receiving reports from the lab about patients with mulitdrug-resistant infections and placing those patient on appropriate Isolation Precautions.
c. The number of IPs in the program per the number of beds.
d. The average amount of money spent on isolation gowns this year as compared to last year.
The average amount of time that elapsed between receiving reports from the lab about patients with mulitdrug-resistant infections and placing those patient on appropriate Isolation Precautions.
The quality of the infection prevention program should be assessed routinely by evaluating customer satisfaction, appropriateness, efficacy, timeliness, availability, effectiveness and efficiency.
APIC Infection Prevention
53
On September 1, there were 30 surgical patients in the hospital. Two of these were post-op patients with SSIs. A total of 75 surgeries were performed in September. Six additional SSIs occurred in patients who had surgery in September. What was the numerator for an incidence rate in September?
a. 30
b. 6
c. 8
d. 75
6
An incidence rate is a measure of the frequency with which an event occurs in a population over a specified period of time. The numerator is the number of new cases of a disease during a specific time period. The denominator is the population over a period of time. The numerator is the number of new cases of a disease during a specific time period. The denominator is the population at risk for the same time period. The incidence rate is equal to the numerator divided by the denominator and multiplied by a constant. Because there were six new cases after Sept. 1, the numerator to calculate the incidence rate is this scenario is 6.
APIC Use of Statistics
54
An employee is exposed to blood and body fluids from a patient whose baseline testing revealed positive results in a rapid HIV test. The most appropriate follow-up test for the patient would be:
a. Western Blot
b. Viral Load
c. HIV polymerase chain reaction
d. CD 4
Western Blot
Rapid HIV tests can offer a result in 15 minutes.
APIC HIV/AIDS
55
Which is an example of actions taken during the Study phase of the "Plan, Do, Study, Act" Performance Improvement Mode?
a. Identifying goals for the project
b. Performing staff education sessions
c. Trending and bench marking of data collected
d. Tweaking the program based on results
Trending and bench marking of data collected
The TJC makes clear in the Infection Control and Prevention Standards that organizations should align the plan with the goal of improving infection rates.
APIC Quality Concepts
56
An infant in the Neonatal ICU (NICU) has been diagnosed with Malassezia furfur fungemia. What is the most likely source of the infection?
a. Intravenous lipid infusions
b. A health care worker's false fingernails
c. Commercial powdered infant formula
d. Respiratory transmission from a colonized family member or health care worker
Intravenous lipid infusions
M. furfur is fungemia that is most often associated with lipid infusions.
APIC General Prinicples
57
Which U.S. Agency requires a respiratory program for HCP?
a. Food and Drug Administration (FDA)
b. The Joint Commission (TJC)
c. Centers for Disease Control and Prevention (CDC)
d. Occupational Safety and Health Administration (OSHA)
Occupational Safety and Health Administration (OSHA)
The OSHA respiratory protection standard requires that the employer implement a respiratory protection program with a qualified administrator as the person who oversees the program, including evaluating the effectiveness of the program.
58
Which of the following two rates would be comparable:
a. CLABSI rate for a unit in which the population changed from Med/Surg to Oncology from one quarter to next.
b. Surveillance definition changes from ventilator-associated pneumonia (VAP) to ventilator-associated events (VAE) from one year to next
c. A unit moves from one floor to another with the population remaining the same.
d. VAE rate in a unit that increased the number of ventilated patients after the end of last quarter
A unit moves from one floor to another with the population remaining the same.
To accurately trend surveillance data over time within a facility or compare rates between facilities, surveillance criteria must be consistently used to determine the presence of an HAI, occurrence of an event, or compliance with a process.
APIC Surveillance
59
Which of the following are CDC requirements for storing endoscopes?
1) Store them coiled in the original case
2) Store them in a bin
3) Store hanging in a vertical position to facilitate drying
4) Store in a manner that protects the scope from contamination
a. 1,4 b. 1,2 c. 2,3 d. 3, 4
Store hanging in a vertical position to facilitate drying
Store in a manner that protects the scope from contamination
Endoscopes should be stored in a manner that protects them from contamination.
APIC Surevillance
60
The following data on incidence rates of VAP in the Surgical ICU were collected.
Jan - 7, Feb 9, Mar 4, April 3, May 4, June 2
The best interpretation of the data in the graph is:
a. The number of cases of VAP was higher in January than in May.
b. The number of cases of VAP was the same in January and February.
c. Prevalence of VAP was lowest in June
d. The incidence rate of VAP was highest in Feb.
The incidence rate of VAP was highest in Feb.
Incidence rate is calculated as the number of new cases divided by the population at risk. The graph presents the data as incidence rates, and the rate in Feb was higher than the rate for any other month.
61
A Major difference between a prospective and retrospective study is that the prospective study:
a. Requires a relatively small number of subjects
b. Is usually used for testing initial hypotheses.
c. May require a long follow-up period.
d. Is usually less costly
May require a long follow-up period
A retrospective study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study.
A prospective cohort study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. Prospective studies usually have fewer potential sources of bias and confounding than retrospective studies
APIC Research Study Design
62
Program evaluation is necessary to measure change and growth in the learner. The following program elements should be evaluated in order to demonstrate efficacy and impact.
1) . Appropriateness of the program design.
2) . Adequacy of the teaching and instructional resources.
3) Knowledge, skills, and attitudes learned by the participants.
4) . Assessing the educational needs of the attendees.
a. 1,2,3 b. 1,3,4 c. 2,3,4 d. 1,2,4
Appropriateness of the program design.
Adequacy of the teaching and instructional resources.
Knowledge, skills, and attitudes learned by the participants.
Program evaluation is a systematic method for collecting, analyzing, and using information to assess the effectiveness and efficiency of the educational offering.
APIC Education and Research
63
What type of personal protective equipment (PPE) should be used for environmental cleaning of grossly contaminated areas during outbreaks of norovirus in long-term care facilities (LTCFs)?
a. coveralls and N95 respirators.
b. Gowns and gloves
c. Masks, gowns and gloves
d. Gloves, gowns and goggles
Masks, gowns and gloves
Norovirus is a common cause of viral gastroenteritis in nursing homes. Outbreaks occur in nursing homes and other LTCFs each year, most commonly in the winter. LTCF incorporate the CDC Isolation Precautions. Gowns and gloves are indicated during environmental cleaning of grossly contaminated areas. Masks must also be worn because spattering or aerosolization of infectious material may be involved in disease transmission.
APIC - Long-term care
64
An IP receives a call from the Emergency Room. They are treating a child with presumptive pertussis. The IP's recommendations for managing this patient should include:
a. Standard plus Contact Precautions.
b. Contact plus Droplet Precautions.
c. Airborne Isolation Precautions.
d. Standard plus Droplet Precautions.
Standard plus Droplet Precautions
Pertussis (whooping cough) is highly communicable, acute, infectious respiratory disease caused by Bordetella pertussis. Transmission occurs by direct contact with respiratory secretions or large aerosol droplets from the respiratory tract of infected persons. The CDC recommends isolating suspected or known infected patients using Standard plus Droplet Precautions.
APIC Isolation Precautions
65
The NICU Medical Director has requested the NICU CLABSI rate. He wants baseline data and asks the IP to design and implement a hand hygiene improvement campaign, using the CLABSI rate as one of the outcome indicators. What information is needed from the NICU in order to best risk-stratify data?
a. Birth weight
b. Length of stay
c. Gestation
d. Gender
Birth weight
Rate of neonatal HAI are influenced by the patient population, level of care provided, proportion of infants of very low and low birth weight, extent of device utilization, surgical procedures performed, intensity of surveillance, types of infections reported, denominators used, and, lastly whether or not infections of maternal origin are included. The CDC's NHSN stratifies data by birth weight groups, using birth weight as a marker for severity of underlying illness.
APIC Neonates
66
Which placement decision should the IP recommend when cohorting is required for a resident colonized with VRE in an LTCF?
a. Cohort the resident colonized with VRE with a roommate who is already on contact isolation for an MDRO.
b. Cohort the resident colonized with VRE with a roommate who has an indwelling urinary catheter because use of the shared bathroom will be limited.
c. Residents colonized with VRE in LTCFs do not require special placement considerations.
d. Cohort the resident colonized with VRE with a roommate who is healthy and at low risk for developing an infection and use Contact Precautions.
Cohort the resident colonized with VRE with a roommate who is healthy and at low risk for developing an infection and use Contact Precautions.
Isolation precaustions present a challenging issue for LTCFs and residents. Placing a resident in isolation will prevent them from attending activities and group functions and may have a negative impact socially and psychologically.
APIC Long-term Care
67
A pregnant healthcare workers is concerned because she has been assigned to take care of a patient who has cytomegalovirus (CMV) infection. How should an IP respond to this concern?
a. Reassign her to another patient.
b. Place the patient on Contact Precautions while the healthcare workers cares for him.
c. Advise her that following Standard Precautions while caring for the patient will prevent transmission.
d. Advise her that she is likely already infected with CMV and should not worry about transmission.
Advise her that following Standard Precautions while caring for the patient will prevent transmission.
CMV is transmitted through saliva, urine, and blood products and organs. The CDC recommends using Standard Precautions when caring for patients with CMV, with no additional precautions recommended for pregnant HCP.
APIC Education and Research
68
In a published report on the risk of VRE infection in ICUs of a major teaching hospital, the authors report that the relative risk of infection is 1.9 for the Cardiac ICU when compared to the SICU, and they conclude that a stay in the CICU is a risk factor for VRE infection. The authors have not controlled for age in their study despite the fact that their CICU patients average 20 years older than their SICU patients, and older age is a risk factor for VRE infection. The IP is concerned about the conclusions of this study because he suspects which of the following?
a. The study is affected by selection bias
b. The study is affected by standard error
c. The study is affected by confounding
d. The study is affected by causation
The study is affected by confounding
A confounding variable is an extraneous variable that is statistically related to the independent variable. This means that as the independent variable changes, the confounding variable changes along with it. The result is that subjects in one condition are different in some unintended way from subjects in the other conditions. Confounding can lead to the assumption that there are differences that do not really exist or to the observation that here is no difference when one truly exists.
APIC General Principles
69
Inadequate refrigeration of food may permit the growth of potentially harmful microbes. Interventions to prevent growth of pathogens due to inadequate refrigeration include:
1) Train personnel to recognize and implement safe maintenance of refrigerators.
2) Establish a method to record temperature on a regular basis.
3) Make daily rounds to ensure that the freezer and refrigerator are clean.
4) Schedule and perform regular preventative maintenance of freezer and refrigerator.
a. 1,2,3 b. 1,2,4 c. 2,3,4 d. 1,3,4
Train personnel to recognize and implement safe maintenance of refrigerators.
Establish a method to record temperature on a regular basis.
Schedule and perform regular preventative maintenance of freezer and refrigerator.
APIC Maintenance and Engineering
70
Which of the following patient care units would be the best choice for conducting surveillance on wound infections with drug-resistant Gram-negative rod bacteria to prevent outbreaks?
a. The Burn Unit
b. The Orthopedic Medical/Surgical Unit
c. The CICU
d. The General Medical/Surgical unit
The Burn Unit
Infection is the leading cause of morbidity and mortality in burn patients, despite improvements in care.
APIC Burns
71
Which of the following is an example of the criterion of "Strength of the Association" from Hill's criteria for causation?
a. In a study of the association between antibiotic exposure and development of C. difficile infection, the odds ratio was 2:3
b. In a study of the association between antibiotic exposure and development of C. difficile infection, the author's conclusions are consistent with those of three other studies.
c. In a study of the association between antibiotic exposure and development of C. difficile infection, antibiotic therapy began an average of 3 weeks before C. difficile infection developed.
d. In a study of the association between antibiotic exposure and development of C. difficile infection, prolonged antibiotic therapy was a greater risk for C. difficile infection than short-term antibiotic therapy.
In a study of the association between antibiotic exposure and development of C. difficile infection, the odds ratio was 2:3
Causal associations exist when evidence indicates that one factor is clearly shown to increase the probability of the occurrence of a disease.
APIC General Principles of Epidemiology
72
The "epidemiological triangle" model for disease causation does NOT include:
a. Agent
b. Host
c. Time
d. Environment
Time
APIC General Principles of Epidemiology
73
The occurrence of new cases or events in a specific population during a given time period is defined as the:
a. Incidence rate
b. Attack rate
c. Incident density
d. Prevalence
Incidence rate
A rate measures the probability of occurrence in a population of some particular event, such as cases of disease or deaths.
APIC Surveillance
74
Patients with mycoplasma pneumonia should be cared for in which type of precautions?
1) Standard Precautions
2) Airborne Precautions
3) Droplet Precautions
4) Contact Precautions
a. 1,2 b. 3,4 c. 1,3 d. 1,4
Standard Precautions
Droplet Precautions
Mycoplasma pneumonia is spread by respiratory droplets during close contact with a symptomatic person. In addition to Standard Precautions, Droplet Precautions are recommended for the duration of symptomatic illness.
APIC Preventing /Controlling the Transmission of Infectious Agents
75
When providing educational activities for the adult learner, what type of feedback will facilitate translation of new skills or knowledge to the work setting?
a. knowledgeable critiques to ensure proficiency
b. Coaching to ensure confidence of knowledge and skills learned
c. Confidential review of test results to ensure mastery of content
d. Documentation of completion of mandatory requirements
Coaching to ensure confidence of knowledge and skills learned
APIC Education and Training
76
Epidemic keratoconjunctivitis (EKC) is a viral conjunctivitis caused by a group of adenoviruses. EKC is highly contagious and can be problematic in ambulatory surgery settings. Recommended measures for control of these infections include:
1) Disinfection of tonometer tips in 3% hydrogen peroxide.
2) sterilize ophtalmoscopes between uses
3) Disinfection of the environment
4) Frequent hand hygiene
a. 2,3,4 b. 1,2,4 c. 1,3,4 d. 2,3,4
Disinfection of tonometer tips in 3% hydrogen peroxide.
Disinfection of the environment
Frequent hand hygiene
APIC Ophthalmology Services
77
All of the 72 patients in a chronic hemodialysis center were tested for Hepatitis C virus (HCV). Eight of he patients were identified as HCV positive. During the following year, two of the dialysis center's patients who previously tested negative for HCV converted to HCV positive. What was the incidence for that year?
a. 2.8%
b. 3.1%
c. 13.8%
d. 7.2%
3.1%
An incidence rate is a measure of the frequency with which an event occurs in a population over a specified period of time. Incidence indicates the risk of disease in a population over a period of time. The incidence rate equals the number of new cases of a disease for a specified time period divided by the population at risk for the same time period multiplied by a constant.
2/64 x 100 = 3.125
APIC Use of Statistics in Infection Control
78
The manufacturer of a wound dressing product has notified the hospitals' Purchasing Department of possible contamination of one lot of dressings. The dressings were recently approved by the Product Standardization Committee and are used in all patient care areas. Which of the following actions should the IP take?
a. Instruct the Purchasing Department to remove all the manufacturer's dressing and like products from the hospital.
b. Notify discharged patients who were using the product while in the hospital to be alert for signs of infection and notify their physician and the IP Department.
c. Identify where the dressing are in the hospital, check the lot number and return them to the manufacturer, and assess the patients who used the product for signs of infection.
d. Notify the Health Department of the recall and provide the names of the patients who used the product.
Identify where the dressing are in the hospital, check the lot number and return them to the manufacturer, and assess the patients who used the product for signs of infection.
APIC Sterile Processing
79
An IP has completed the investigation of an increase in postdischarge SSIs following ambulatory surgical procedures. He identified some corrective measures that will require monitoring. Which of the following actions should the infection Prevention team take?
a. Monitor the cleaning of the surgical suites
b. Ensure the effectiveness of the ventilation system
c. Revise the facility's surveillance plan
d. Ensure that patient care equipment is adequately cleaned
Revise the facility's surveillance plan
APIC Surveillance
80
All of the 72 patients in a chronic hemodialysis center were tested for Hep C virus (HCV). Eight of the patients were identified as HCV positive. What is the prevalence?
a. 0.9%
b. 9%
c. 1%
d. 11%
11%
8/72 X100 = 11%
81
Attack rates are usually expressed as:
a. Ratio
b. Raw Numbers
c. Historical run charts
d. A percentage
A percentage
An attack rate is a special form of incidence rate. In fact, it is not truly a rate, but a proportion. It is a proportion of persons at risk who become infected over an entire period of exposure or a measure of the risk who become infected over an entire period of exposure or a measure of the risk or probability of becoming a case. It is usually expressed as a percentage.
APIC Surveillance
82
An IP is asked to participate in the selection of a company to reprocess single-use devices (SUDs). Before a decision is made on which reprocessing company will be used, the IP reviews available information from a variety of resources to assist with the decision making. Which of the following activities should the IP recommend the hospital undertake?
a. Talk to other infection preventionists about which sterilizing methods to use on the SUDs.
b. Visit reprocessing companies under consideration
c. Create quality control records for the SUDs
d. Identify the patients on which the reprocessed SUDs, as opposed to new devices, will be used.
Visit reprocessing companies under consideration
APIC Reprocessing
83
What is the first action HCP should take after a needle-stick exposure?
a. Contact the supervisor
b. Contact Occupational Health
c. Squeeze or milk the site
d. Wash the affected area
Wash the affected area
APIC Employee/Occupational Health
84
An IP collected the following data from the ICU for the month of March. How would she calculate the CAUTI rate the month of March?
6 CAUTIs
240 Patient days
180 catheter days
a. (6/240) x 1,000 = 25 per 1,000 patients days
b. (6/180) x 1,000 = 33.3 per 1,000 catheter days
c. (180/240) x 1,000 = 750 per 1,000 patient days
d. (240/180) x 1,000 = 1333.3 per 1,000 patient days
(6/180) x 1,000 = 33.3 per 1,000 catheter days
A rate is calculated by dividing the numerator (number of occurrences) by the denominator ( number of opportunities for that occurrence) and then multiplying by a constant.
APIC Use of Statistics in Infection Prevention
85
The Director of Infection Prevention and Control is developing an educational program to provide annual blood-borne pathogen training to healthcare personnel in her facility. There are approximately 7,500 employees who need annual training, and her team of the five IPs has to provide and document this training while still carrying out all other department duties. What is the best method of delivery for this training?
a. Web-based training sessions
b. Educational cart
c. Group lecture sessions
d. Role play training sessions
Web-based training sessions
APIC Education and Traning
86
Important elements of surveillance programs include:
1) Tracking diseases associated with the healthcare environment.
2) Environmental sampling
3) Reviewing microbiology reports for antibiotic resistant organisms
4) Tracking and reporting HAIs as mandated by state/local public health requirements
a. 1,2,4 b. 1,3,4 c. 1,2,3 d. 2,3,4
Tracking diseases associated with the healthcare environment.
Reviewing microbiology reports for antibiotic resistant organisms
Tracking and reporting HAIs as mandated by state/local public health requirements
87
Which of the following statements is TRUE regarding statistical process control (SPC)?
a. May be used to monitor outcomes or processes of care.
b. Ensures quality when focus remains on infectious processes.
c. Identifies HAIs as data points
d. Focuses on the use of run charts, rather than control charts, to measure variaion
May be used to monitor outcomes or processes of care.
APIC Surveillance and Epidemiologic Investigation
88
The CDC has categorized bioterrorism agents according to priority. A disease that meets the criteria listed under Category B is:
a. Anthrax
b. Typhus
c. Hantavirus
d. Measles
Typhus
Agents classified by CDC as Category A are biological agents that have high potential for adverse public health impact, increased risk to national security, serious potential for large-scale dissemination, potential for public panic, social disruption, and high mortality rates. Category B agents have a moderate ease in disseminating, specific requirements for disease surveillance, moderate morbidity rates, and low mortality. Typhys (Rickettsia prowazekii) meets the Category B criteria.
89
Nursing Administration has announced the opening of a simulation lab at an acute care facility. The IP has been asked to develop a simulation setting dedicated to teaching infection prevention best practices. Which of the following is an example of a simulation activity?
a. creating an isolation room to practice use of isolation precautions.
b. modeling proper hand hygiene techniques and having participants model back.
c. showing an interactive video of cleaning procedures and asking participants to identify correct and incorrect elements.
d. setting up a display of education materials concerning influenza vaccinations
creating an isolation room to practice use of isolation precautions.
APIC Education and research
90
The IP at a long-term acute care (LTAC) facility is reviewing her surveillance data. Due to the high-risk nature of the LTAC's patient population, infection control data include a large number of outliers. Which measure of central tendency is least affected by outliers?
a. Proportions that include the population in the numerator.
b. Proportions that include the population in the denominator and a subset of the population in the numerator
c. Arithmetic mean
d. Median
Median
APIC Surveillance and Epidemiologic Investigation
91
The Infection Prevention Committee is monitoring an uncommon event. To calculate rates, which of the following statements about the time period of observation is accurate?
a. Any period of time can be used according to a pre-established time frame.
b. Period of time must be sufficient to accrue a sufficient number of events.
c. A flexible time period may be used if indicated.
d. A time frame dictated by the National Healthcare Safety Network should be used.
Period of time must be sufficient to accrue a sufficient number of events.
APIC Surveillance and Epidemiologic Investigation
92
A staff nurse informs the IP that a patient with confirmed multi-drug resistant TB requires an immediate bronchoscopy. In which of the following rooms must the procedure be performed?
a. The operating room under positive pressure
b. standard procedure room in the endoscopy suite
c. the ICU with direct exhaust to the outside
d. airborne infection isolation room
airborne infection isolation room
APIC Endoscopy
93
In a Gram stain procedure, Gram-positive bacteria stain purple because:
a. They have a lipopolysaccharide layer in their cell wall that is decolorized with alcohol
b. Their cell walls contain long-chain fatty acids that take up crystal violet easily
c. They have a thick peptidoglycan cell wall that retains the primary stain during the alcohol decolorization
d. Gram-staining is simple staining so the only stain used is crystal violet.
They have a thick peptidoglycan cell wall that retains the primary stain during the alcohol decolorization.
APIC Microbiology basics
94
Hepatitis A is diagnosed by the presence of:
a. Immunoglobulin G (IgG) for anti-Hepatitis D virus (HDV)
b. Hepatitis A virus (HAV) immunoglobulin M (IgM)
c. Increase in anti-Hepatitis B virus (HBV) - related to previous Hepatitis B infection
d. HAV IgG
Hepatitis A virus (HAV) immunoglobulin M (IgM)
APIC Viral Hepatitis
95
The Director of Infection Prevention and Control at a 600-bed acute care facility is notified of plans to add 150 beds to the ICU in an expansion. There is one other full-time IP in the department, and the Director would like to hire one more to have a total of three full-time IPs in the department. Which of the following is the best justification to make to administration for hiring one more IP?
a. The CDC requires that there is one full-time IP for every 250 beds occupied beds.
b. TJC requires that there is one full-time IP for every 100 beds.
c. Adding one more IP will free some of the Director's time to allow her to focus on research projects.
d. A cost-benefit analysis shows that adding one more IP will result in a reduction in HAI's that will offset 200 percent of the new IPs salary.
A cost-benefit analysis shows that adding one more IP will result in a reduction in HAI's that will offset 200 percent of the new IPs salary.
APIC Infection Prevention
96
Which method of face-to-face instruction is a useful option when large numbers of staff must be educated over a relatively short span of time?
a. Role play
b. Mentoring
c. Case Studies
d. Train the trainer
Train the trainer
APIC Education and Training
97
An Ip conducts an audit of the OR cleaning process. The action that would be most concerning would be:
a. The operating room is terminally cleaned at the end of each business day.
b. The decontamination process starts on the floor of the OR and works upward toward the lighting.
c. The cleaning solutions are prepared daily.
d. A wet vacuum and microfiber mop head are used to clean the OR floors.
The decontamination process starts on the floor of the OR and works upward toward the lighting.
APIC Surgical Services
98
Strategies to prevent infection of a dialysis access site include the following:
1) . Utilize an arteriovenous (AV) graft if a fistula cannot be established.
2) Use a tunneled cuffed catheter for acute dialysis if use will be more than 3 weeks
3) Subclavian access is preferred over jugular options.
4) Use femoral catheters only in bed bound patients for no more than 5 days.
a. 1,3,4 b. 1,2,4 c. 2,3,4 d. 1,2,3
Utilize an arteriovenous (AV) graft if a fistula cannot be established.
Use a tunneled cuffed catheter for acute dialysis if use will be more than 3 weeks
Use femoral catheters only in bed bound patients for no more than 5 days.
APIC - Dialysis
99
Fifteen persons were infected with Salmonella at a picnic where 75 ate egg salad sandwiches. What was the attack rate of Salmonella among those who ate salad sandwiches?
a. 15 percent
b. 0.20 percent
c. 18 percent
d. 20 percent
20 percent
15/75x100 = 20 percent
APIC Use of Statistics
100
A patient has been admitted with a wound infection. The lab reports that the stain of the wound culture is positive for AFB and the culture is positive for Mycobacterium mariunum. Which of the following is correct follow-up of this lab report?
a. No further follow-up is needed
b. Place the patient on airborne isolation
c. Contact the local health department to report the Mycobacterium infection
d. Place the patient on Contact Precautions
No further follow-up is needed
APIC preventing and controlling the Transmission of Infectious Agents
101
Examples of efforts to improve patient safety in the healthcare setting include:
1) Encouraging patients to ask their healthcare providers if they washed their hands
2) medication safety programs that report medication errors and inform staff of efforts to prevent repeated errors
3) Encouraging patients to ask questions about their treatments and medications
4) Emphasizing punitive reactions to mistakes
a. 1,2,4 b. 1,2,3 c. 2,3,4 d. 1,3,4
Encouraging patients to ask their healthcare providers if they washed their hands
medication safety programs that report medication errors and inform staff of efforts to prevent repeated errors
Encouraging patients to ask questions about their treatments and medications
APIC Patient Safety
102
Which short-term central lines are associated with a higher risk of infection?
1) Peripherally-inserted central venous catheters (PICC)
2) Femoral lines
3) Subclavian lines
4) Jugular lines
a. 1,2 b. 2,3 c. 2,4 d. 1,4
Femoral lines
Jugular lines
APIC Preventing/controlling the Transmission of Infectious Agents
103
A technician finds out after obtaining an EKG on a patient that the patient may have varicella-zoster (shingles) on a dermatome on the upper body. The Occupational Health Nurse checks the employee's records and realizes that the employee was never tested for varicella on hire. The first thing the Occupational Health Nurse should do is:
a. Determine if the patient actually has an active case of varicella-zoster by involving the IP or checking with the patient's physician to verify the diagnosis.
b. Test the employee for varicella immunity and, if not immune, exclude from work from day 10 through day 21 after the exposure.
c. Give the varicella vaccine to the employee
d. Give varicella-zoster immune globulin (VZIG) to the employee
Determine if the patient actually has an active case of varicella-zoster by involving the IP or checking with the patient's physician to verify the diagnosis.
APIC Employee / Occupational Health
104
A healthcare worker has had her uniform scrub top contaminated by a large blood spill that has penetrated the fabric. Choose her best option for follow-up from the choices below.
a. She should be sent home immediately to take a shower.
b. She should remove the top by carefully pulling it over her head and then launder it in a washing machine with hot water and bleach.
c. She should remove the scrub top by using scissors to cut it off and discard it in a bio-hazard-labeled container
d. She should remove the top by pulling it over her head and then discard it in the trash.
She should remove the scrub top by using scissors to cut it off and discard it in a bio-hazard-labeled container
APIC Preventing / Controlling the Transmission of Infectious Agents
105
Alcohol-based hand rubs can be used in which situation?
a. Visibly soiled hands
b. After using the bathroom
c. Caring for a patient with C. Difficile
d. Before and after direct patient contact
Before and after direct patient contact
APIC
APIC Preventing / Controlling the Transmission of Infectious Agents
106
During environmental rounds, the IP observes an environmental service worker cleaning up a blood spill on the floor. The best choice for cleaning blood and body fluids is:
a. Alcohol
b. Quarternary ammonium compound
c. Phenolic
d. Bleach
Bleach
APIC Preventing / Controlling the Transmission of Infectious Agents
107
The standardized Infection Ratio (SIR) for CLABSI in the ICU is 0.8. Which of the following is incorrect?
a. There were more CLABSIs in the ICU than expected.
b. There are fewer CLABSIs in the ICU than expected.
c. There was a 20 percent reduction in CLABSIs this year from the baseline period
d. Progress has been made in CLABSI reduction
There were fewer CLABSIs in the ICU than expected.
APIC Surveillance and Epidemiologic Investigation
108
Which of the following quality concepts will identify a pattern of observation point above and below the mean level?
a. Fishbone diagram
b. Run chart
c. Pareto chart
d. Process flow chart
Run chart
APIC Quality Concepts
109
Which of the following is NOT an advantage of a case-control study:
a. It takes less time than a cohort study
b. It requires fewer subjects
c. The data are more accurate because it is prospective
d. It is generally considered less expensive
The data are more accurate because it is prospective
APIC Education and Research
110
The IP has confirmed that there is an outbreak of MRSA SSIs in eight women who have had cesarean sections in this facility within the past month. A preliminary review of cases indicates that they all had emergent cesarean sections with ruptured membranes, whereas all of the selected controls had planned cesarean sections. There were no differences in OR staff members or location of the procedures between the two groups. Based on that, the most appropriate hypothesis for a case-control study would be:
a. Fetal monitoring belts are not being adequately cleaned and disinfected.
b. Skin antisepsis is not being carried out correctly prior to emergent cesarean sections
c. Operating room ventilation is not functioning properly.
d. A member of the surgical team is colonized with MRSA
Skin antisepsis is not being carried out correctly prior to emergent cesarean sections
APIC General Principles of Epidemiology
111
An outbreak of Hepatitis C (HCV) has occurred in the endoscopy clinic. Single-dose vials of medication are used in the clinic and observation of practice shows that the rubber stopper of each vial is wiped with alcohol before access. Medication is drawn up with a needle and syringe and administered to the patient. If an added dose is needed, the needle is replaced on the syringe and more medication is drawn up from the vial. If medication remains in the vial, then it is stored at the recommended temperature for use on another patient. HCP in the clinic had a 40 percent overall complication with recommended hand hygiene practices. Which practice is the most likely cause of the outbreak?
a. Use of single-dose mediation vial for more than one patient
b. Poor hand hygiene practices
c. Contamination of medication through the rubber stopper
d. Failure to replace the syringe when re-accessing the medication vial after administering a first dose of the medication
Use of single-dose mediation vial for more than one patient
APIC Preventing /Controlling the Transmission of Infectious Agents
112
What is an advantage of experimental studies when identifying approaches to successfully interrupt the chain of infection?
a. Experimental studies can identify causative disease factors retrospectively
b. Experimental studies can establish association and causality if host factors such as disease susceptibility and other variables are strictly controlled
c. Experimental studies avoid the need to manipulate the independent variable, and therefore ethical issues associated with exposure to disease
d. Experimental studies do not require randomization, which is difficult to achieve in the healthcare environment.
Experimental studies can establish association and causality if host factors such as disease susceptibility and other variables are strictly controlled
APIC General Principles of Epidemiology
113
The IP wants to calculate the surgeon-specific rate of infections associated with spinal fusion surgeries in the facility. Which of the following data elements will he need?
1) Number of spinal fusion procedures within the designated time frame.
2) Number of spinal fusion SSIs within the designated time frame.
3) Number of spinal fusion surgeries performed by each surgeon within the designated time frame.
4) Number of spinal fusion infections for each surgeon within the designated time frame.
a. 1,2 b. 1,4 c. 2,3 d. 3,4
Number of spinal fusion surgeries performed by each surgeon within the designated time frame.
Number of spinal fusion infections for each surgeon within the designated time frame.
APIC Surveillance and Epidemiologic Investigation
114
A blood spill contaminated a pneumatic tube system and its contents. The leak was not identified for a period of time. After remediation of the contamination, the IP recommends the following to prevent a future incident.
a. Establish a method to recognize spills or leaks
b. Perform a hazard vulnerability analysis
c. Contract with an outside vendor to clean and maintain system.
d. Restrict the use of pneumatic tube to nonhazardous material
Establish a method to recognize spills or leaks
APIC Maintenance and Engineering
115
A healthcare facility is undergoing extensive renovation. Surveillance for which of the following organisms would be particularly important during any construction or renovation project in a healthcare facility?
a. MRSA, VRE, and other MDROs
b. Legionella and Aspergillus
c. Gram-negative bacilli
d. Mycobacterium abscessus
Legionella and Aspergillus
APIC Construction and Renovations
116
An outbreak of norovirus in an LTCF would most likely have an epidemiological curve (EPI curve) that:
a. Indicated a common source of infection
b. Indicated a propagated source of infection
c. Indicated a point source of infection
d. Indicated a common vehicle of infection
Indicated a propagated source of infection
APIC Outbreak Investigations
117
What is the term for an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof?
a. Error
b. Adverse event
c. Near miss
d. Sentinel event
Sentinel event
APIC Patient Safety
118
The incubation period for meningococcal meningitis is:
a. 10 to 14 days
b. 7 to 21 days
c. 2 to 10 days
d. 1 to 2 days
2 to 10 days
The incubation period for meningococcal meningitis is between 2 to 10 days, commonly 3 to 4 days
119
A patient has been diagnosed with Legionnaires' disease that was possibly acquired during his stay in the hospital. What is the recommended first response to this incident?
a. All water sites in the healthcare facility to which the patient was exposed should be cultured for L. pneumophila.
b. The patient should be placed on respiratory isolation until 24 hours after treatment has started.
c. The water system should be super heated and flushed immediately
d. All patients should immediately be provided with bottled water for drinking.
All water sites in the healthcare facility to which the patient was exposed should be cultured for L. pneumophila.
APIC Legionella pneumophile
APIC Water Systems Issues and Prevention of Waterborne Infectious Disease in Healthcare Facilities
120
Properly written instructional objectives include:
a. Statements that communicate the intent of the curriculum
b. Directions and plans for the educational session
c. Learner outcomes in measurable terms using action verbs
d. Measures of change and growth in the learner
Learner outcomes in measurable terms using action verbs
APIC Education and Training
121
The key to cleaning and disinfection of environmental surfaces is the:
a. use of specific antiseptics for each surface
b. Physical removal of visible dirt, organic material, and debris
c. Assignment of trained staff to each department
d. Maintenance of equipment used for cleaning
Physical removal of visible dirt, organic material, and debris
APIC Environmental services
122
What key strategy should the IP use to meet the administrative challenges of outpatient settings that are geographically dispersed?
a. Standardized measurement and definitions for HAIs consistent with those used for inpatient settings
b. HAI comparison with external benchmarks for all sites
c. Development of communication networks between sites, hospital, and health departments.
d. Standardized infection prevention policies and procedures
Development of communication networks between sites, hospital, and health departments.
APIC Ambulatory Care
123
A hospital administrator has proposed that single-use angiography catheters be reprocessed and reused to cut costs. What is the best response to this request?
a. Single-use items are not allowed to be reprocessed.
b. A cost-benefit analysis should be done before a decision is made
c. Single-use items can be reprocessed in the facility as long as administration, Risk Management, Legal Counsel, Supply Chain Administrator, and Infection Prevention representatives say it is allowed.
d. Single-use items can be reprocessed in a third-party facility if FDA guidelines are followed.
Single-use items can be reprocessed in the facility as long as administration, Risk Management, Legal Counsel, Supply Chain Administrator, and Infection Prevention representatives say it is allowed.
APIC Product evaluation
124
Which of the following need to be considered when updating the annual infection risk assessment?
1) An evaluation of the previous year's goals and objectives.
2) An identification of risks based on geographic location, community, and population served
3) Risks related to the type of services that the facility provides
4) A broad assessment of all risks identified on the facility
a. 1,2,4 b. 1,2,3 c. 2,3,4 d. 1,3,4
An evaluation of the previous year's goals and objectives.
An identification of risks based on geographic location, community, and population served
Risks related to the type of services that the facility provides
APIC Infection prevention and control
125
In 2013 - 565 persons died from influenza-related illness in a large metropolitan area with a population of 1.8 million. What was the cause-specific mortality rate?
a. 31 per 100,000
b. 53 per 100,000
c. 31 percent
d. 0.03 percent
31 per 100,000
Mortality rate = x/y x k
x = number of people in a population who died (565)
y = number is the population at mid year (100,000)
or in this case (1,800,000)
k = an assigned value of 1,000
565 / 1,800,000 x 1,000 = 31 per 100,000
126
Which of the following would be considered biomedical waste?
a. Diaper soiled with feces
b. Blood-tinged suctioned fluids
c. Wound dressing that is not saturated
d. Isolation gown worn to deliver food tray
Blood-tinged suctioned fluids
APIC Waste Management
Preventing and controlling the transmission of infectious Agents
127
The IP identifies a cluster of positive cultures of non-tuberculosis mycobacteria involving six different patients. Which of the following activities should be done first?
a. Perform a case control study
b. Notify the public health department
c. Confirm the presence of a cluster
d. Perform a critical incident review
Confirm the presence of a cluster
APIC Outbreak Investigation
Surveillance and Epidemiologic Investigation
128
The Local Health Department informs the IP that a nurse in the CICU has been diagnosed with measles immediately after returning from a trip to Europe. His symptoms began 2 days ago, and he last worked in the unit 9 days ago. The incubation period for measles is 8 to 12 days, and the period of contagion is 1 to 2 days prior to onset of symptoms. How should the IP follow up on this report?
a. Determine the susceptibility to measles of all HCP and patients who had contact with the nurse in the past 12 days
b. Place all patients who were cared for by the nurse in Airborne isolation
c. Inform Occupational Health about the infection so that they can furlough the employee for the appropriate amount of time
d. The IP does not need to conduct any follow-up
Inform Occupational Health about the infection so that they can furlough the employee for the appropriate amount of time
APIC Measles, Mumps and Rubella
Occupational Health
129
A patient who had neurosurgery was exposed to Creutzfeldt-Jakob disease (CJD) prions through surgical instruments that were not correctly processed after having been previously used on an infected patient. As a result, she has developed the disease herself. This is an example of which mode of infection?
a. Familial CJD
b. Iatrogenic CJD
c. Spontaneous CJD
d. Mutational CJD
Iatrogenic CJD
APIC Creutzfeldt-Jakob disease (CJD) and other Prion diseases
Identification of Infectious Disease Process
130
Which of the following Transmission-based Precautions category requires a negative airflow room?
a. Contact Precautions
b. Airborne Precautions
c. Droplet Precautions
d. Standard Precautions
Airborne Precautions
APIC Isolation Precautions
Preventing/Controlling the transmission of infectious agents
131
When considering occupational health issues in healthcare settings, which individuals are covered under the term "healthcare personnel"?
1) All paid persons working in healthcare setting who have the potential for exposure to infectious materials
2) All paid and unpaid persons working in healthcare settings who have the potential for exposure to infectious materials
3) Any individuals who has the potential to acquire or transmit infectious agents during the course of his or her work in healthcare
4) All paid and unpaid persons who work in healthcare settings and encounter patients
5) All workers employed by the healthcare organization
a. 1,5 b. 2,3 c. 1,4 d. 4,5
All paid and unpaid persons working in healthcare settings who have the potential for exposure to infectious materials
Any individuals who has the potential to acquire or transmit infectious agents during the course of his or her work in healthcare
APIC Occupational Health
Employee / Occupational Health
132
What is the positive predictive value of the following data?
True disease positive True Disease Negative
Test result positive 100 3
Test result negative 40 500
a. 97.0 percent
b. 92.5 percent
c. 96.2 percent
d. 99.4 percent
97.0 percent
The positive and negative predictive values are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results.
The positive predictive value is the proportion of people with positive test results who have the disease.
Positive predictive value = TP/(TP + FP)
The positive predictive value for this question is calculated as follows: 100 + (100 + 3) = 0.97 or 97%.
APIC Use of Statistics in Infection Prevention
Surveillance and Epidemiologic Investigation
133
All of the following would be considered prevention strategies to reduce the transmission of infections in a healthcare setting EXCEPT:
a. Implementing an influenza vaccine program for employees
b. Educating staff members in PPE usage
c. Decolonization of MRSA - positive patients prior to surgery
d. Instituting use of bleach for cleaning C. difficile patient rooms
Decolonization of MRSA - positive patients prior to surgery
APIC General Principles of Epidemiology
Preventing /Controlling the Transmission of Infectious Agents
134
IPs in an ambulatory care setting should base their specific infection prevention strategies on which of the following?
a. Time and duration of surgery
b. Practice (procedures) performed and types of patients
c. American Society of Anesthesiologist's Classification of Physical Status score of the patients
d. Classification of the procedures
Practice (procedures) performed and types of patients
APIC Ambulatory Care
Surveillance and Epidemiologic Investigation
135
Which of the following could be a result of a descriptive study on C. difficile in the healthcare setting?
a. The average age of a patient with C. difficile
b. The association between proton pump inhibitors and C. difficle
c. The likelihood of having C. difficle and being placed on a specific unit
d. The lack of hand hygiene by staff resulting in C. difficile acquisition
The average age of a patient with C. difficile
APIC General Principles of Epidemiology
Education and Research
