Pass the CBIC Infection Control CIC Questions and answers with CertsForce

Ongoing education for Infection Preventionists (IPs) is essential due to the rapidly evolving healthcare landscape and emergence of new infectious diseases, regulations, and technologies.

From the APIC Text:

“Professional development is essential to keeping the infection preventionist up to date with the latest knowledge, skills, and strategies for preventing infections.”

The APIC/JCR Workbook also notes:

“Because information related to emerging infectious diseases... changes rapidly... IPs should actively review information for updates and guidance.”

Hand hygiene is a cornerstone of infection prevention, and declining compliance rates pose a significant risk for healthcare-associated infections (HAIs). The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes improving hand hygiene adherence in the "Prevention and Control of Infectious Diseases" domain, aligning with the Centers for Disease Control and Prevention (CDC) "Guideline for Hand Hygiene in Healthcare Settings" (2002). The IP’s survey identifies hand dryness as the primary barrier, likely due to the frequent use of alcohol-based hand sanitizers or soap, which can dehydrate skin. The goal is to address this barrier effectively while maintaining infection control standards.

Option B, "Provide a compatible lotion in a convenient location," is the most appropriate step. The CDC and World Health Organization (WHO) recommend using moisturizers to mitigate skin irritation and dryness, which can improve hand hygiene compliance. However, the lotion must be compatible with alcohol-based hand rubs (e.g., free of petroleum-based products that can reduce sanitizer efficacy) and placed in accessible areas (e.g., near sinks or sanitizer dispensers) to encourage use without disrupting workflow. The WHO’s "Guidelines on Hand Hygiene in Health Care" (2009) suggest providing skin care products as part of a multimodal strategy to enhance adherence, making this a proactive, facility-supported solution that addresses the root cause.

Option A, "Provide staff lotion in every patient room," is a good intention but impractical and potentially risky. Placing lotion in patient rooms could lead to inconsistent use, contamination (e.g., from patient contact), or misuse (e.g., staff applying incompatible products), compromising infection control. The CDC advises against uncontrolled lotion distribution in patient care areas. Option C, "Allow staff to bring in lotion and carry it in their pockets," introduces variability in product quality and compatibility. Personal lotions may contain ingredients (e.g., oils) that inactivate alcohol-based sanitizers, and pocket storage increases the risk of contamination or cross-contamination, which the CDC cautions against. Option D, "Allow staff to bring in lotion for use at the nurses’ station and lounge," limits the intervention to non-patient care areas, reducing its impact on hand hygiene during patient interactions. It also shares the compatibility and contamination risks of Option C, making it less effective.

The CBIC Practice Analysis (2022) and CDC guidelines emphasize evidence-based interventions, such as providing approved skin care products in strategic locations to boost compliance. Option B balances accessibility, safety, and compatibility, making it the best step to address hand dryness and improve hand hygiene rates.

To determine the infection rate per 100 procedures for total hip replacements, use the following formula:

Thus, the correct answer is B. 2.9 per 100 procedures.

CBIC Infection Control Reference

The methodology of calculating SSI rates aligns with guidelines from the National Healthcare Safety Network (NHSN) and standardized infection ratio (SIR) models used for hospital-specific SSI rates​.

The primary source of organisms causing surgical site infections (SSIs) is the patient’s own endogenous flora. Bacteria from the skin, mucous membranes, or gastrointestinal tract contaminate the surgical site, leading to infection. Common pathogens include Staphylococcus aureus, coagulase-negative staphylococci, and Enterobacteriaceae.

Why the Other Options Are Incorrect?

A. Operating room environment – While environmental contamination can contribute, it is not the primary source.

B. Operating room personnel – Infection control measures (hand hygiene, gloves, masks) reduce transmission from personnel.

D. Healthcare personnel’s hands – Although hand contamination is a risk, it is secondary to the patient’s endogenous flora.

CBIC Infection Control Reference

According to APIC guidelines, the patient’s own flora is the primary source of SSIs​.

The CBIC Certified Infection Control Exam Study Guide (6th edition) identifies the randomized clinical trial (RCT) as the study design that provides the strongest evidence of a causal relationship between a risk factor (or intervention) and an outcome. RCTs are considered the gold standard because they use random assignment to allocate participants to either an intervention group or a control group, which minimizes bias and balances both known and unknown confounding variables between groups.

By controlling exposure and randomly assigning participants, RCTs establish temporality, ensuring that the exposure precedes the outcome—an essential criterion for causality. This design also allows for direct comparison of outcomes under controlled conditions, making it possible to attribute observed differences in outcomes to the intervention or risk factor with a high degree of confidence.

In contrast, cohort studies and case-control studies are observational and can identify associations but are more susceptible to confounding and bias. While cohort studies can demonstrate temporal relationships and estimate risk, they cannot control exposures as precisely as RCTs. Case-control studies are particularly vulnerable to recall and selection bias. Cross-sectional studies assess exposure and outcome simultaneously and cannot establish causation.

For the CIC® exam, it is critical to recognize that randomized clinical trials offer the highest level of evidence for causality, particularly when evaluating interventions, preventive measures, or treatment effectiveness in infection prevention and healthcare epidemiology.

The Certification Study Guide (6th edition) explains that during construction, renovation, or maintenance activities in healthcare facilities, negative (reduced) air pressure within the contained work area is a critical engineering control to prevent the spread of dust and potentially infectious microorganisms. When the pressure inside the containment is lower than in adjacent occupied areas, air naturally flows from areas of higher pressure to areas of lower pressure.

As a result, airflow moves from the clean adjacent space into the contained work space, rather than allowing contaminated air to escape outward. Once inside the containment, the air is then exhausted directly to the outside of the building or through appropriate filtration systems. This airflow pattern protects patients, visitors, and healthcare personnel in occupied areas by preventing construction-related contaminants—such as fungal spores (e.g., Aspergillus)—from spreading into patient care environments.

The study guide emphasizes that this principle is foundational to Infection Control Risk Assessments (ICRAs) and construction containment planning. Improper airflow direction can result in airborne contamination and has been associated with outbreaks, particularly among immunocompromised patients.

The incorrect options either reverse the airflow direction or allow contaminated air to re-enter the building, both of which violate infection prevention standards. Understanding airflow dynamics and pressure differentials is a frequently tested concept on the CIC exam and is essential for ensuring safe construction practices in healthcare facilities.

The correct answer is D, "baseline knowledge of the subject," as this is the necessary first step when assessing a patient’s infection prevention and control educational needs. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, effective patient education in infection prevention and control requires a tailored approach that begins with understanding the patient’s existing knowledge and comprehension of the topic. Determining baseline knowledge allows the infection preventionist (IP) to identify gaps, customize educational content to the patient’s level of understanding, and ensure the information is relevant and actionable (CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competency 4.1 - Develop and implement educational programs). This step ensures that education is neither too basic nor overly complex, maximizing its effectiveness in promoting behaviors such as hand hygiene, wound care, or adherence to isolation protocols.

Option A (severity of illness) is an important clinical consideration that may influence the timing or method of education delivery, but it is not the first step in assessing educational needs. The severity might affect the patient’s ability to learn, but it does not directly inform the content or starting point of the education. Option B (educational background) provides context about the patient’s general learning capacity (e.g., literacy level or language preference), but it is secondary to assessing specific knowledge about infection prevention, as background alone does not reveal current understanding. Option C (duration of hospitalization) may impact the opportunity for education but is not a primary factor in determining what the patient needs to learn; it is more relevant to scheduling or prioritizing educational interventions.

The focus on baseline knowledge aligns with adult learning principles endorsed by CBIC, which emphasize assessing learners’ prior knowledge to build effective educational strategies (CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competency 4.2 - Evaluate the effectiveness of educational programs). This approach ensures patient-centered care and supports infection control by empowering patients with the knowledge to participate in their own prevention efforts.

Assessing the effectiveness of an infection control action plan is a critical responsibility of an infection preventionist (IP) to ensure that interventions reduce healthcare-associated infections (HAIs) and improve patient safety. The Certification Board of Infection Control and Epidemiology (CBIC) highlights this process within the "Surveillance and Epidemiologic Investigation" and "Performance Improvement" domains, emphasizing the need for ongoing evaluation and data-driven decision-making. The Centers for Disease Control and Prevention (CDC) and other guidelines stress that the ultimate goal of an action plan is to achieve measurable outcomes, such as reduced infection rates, which requires systematic monitoring and validation.

Option D, "Monitor and validate the related outcome and process measures," is the most important consideration. Outcome measures (e.g., infection rates, morbidity, or mortality) indicate whether the action plan has successfully reduced the targeted infection risk, while process measures (e.g., compliance with hand hygiene or proper catheter insertion techniques) assess whether the implemented actions are being performed correctly. Monitoring involves continuous data collection and analysis, while validation ensures the data’s accuracy and relevance to the plan’s objectives. The CBIC Practice Analysis (2022) underscores that effective infection control relies on evaluating both outcomes (e.g., decreased central line-associated bloodstream infections) and processes (e.g., adherence to aseptic protocols), making this a dynamic and essential step. The CDC’s "Compendium of Strategies to Prevent HAIs" (2016) further supports this by recommending regular surveillance and feedback as key to assessing intervention success.

Option A, "Re-evaluate the action plan every three years," suggests a periodic review, which is a good practice for long-term planning but is insufficient as the most important consideration. Infection control requires more frequent assessment (e.g., quarterly or annually) to respond to emerging risks or outbreaks, making this less critical than ongoing monitoring. Option B, "Update the plan before the risk assessment is completed," is illogical and counterproductive. Updating a plan without a completed risk assessment lacks evidence-based grounding, undermining the plan’s effectiveness and contradicting the CBIC’s emphasis on data-driven interventions. Option C, "Develop a timeline and assign responsibilities for the stated action," is an important initial step in implementing an action plan, ensuring structure and accountability. However, it is a preparatory activity rather than the most critical factor in assessing effectiveness, which hinges on post-implementation evaluation.

The CBIC Practice Analysis (2022) and CDC guidelines prioritize outcome and process monitoring as the cornerstone of infection control effectiveness, enabling IPs to adjust strategies based on real-time evidence. Thus, Option D represents the most important consideration for assessing an infection control action plan’s success.

The correct answer is D, "involves the staff in determining the content," as this approach is most likely to benefit healthcare workers from infection prevention education. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, effective education programs are tailored to the specific needs and contexts of the learners. Involving staff in determining the content ensures that the educational material addresses their real-world challenges, knowledge gaps, and interests, thereby increasing engagement, relevance, and application of the learned principles (CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competency 4.1 - Develop and implement educational programs). This participatory approach fosters ownership and accountability among healthcare workers, enhancing the likelihood that they will adopt and sustain infection prevention practices.

Option A (brings in speakers who are recognized experts) can enhance credibility and provide high-quality information, but it does not guarantee that the content will meet the specific needs of the staff unless their input is considered. Option B (plans the educational program well ahead of time) is important for logistical success and preparedness, but without staff involvement, the program may lack relevance or fail to address immediate concerns. Option C (audits practices and identifies deficiencies) is a valuable step in identifying areas for improvement, but it is a diagnostic process rather than a direct educational strategy; education based solely on audits might not engage staff effectively if their input is not sought.

The focus on involving staff aligns with CBIC’s emphasis on adult learning principles, which highlight the importance of learner-centered education. By involving staff, the IP adheres to best practices for adult education, ensuring that the program is practical and tailored, ultimately leading to better outcomes in infection prevention (CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competency 4.2 - Evaluate the effectiveness of educational programs). This approach also supports a collaborative culture, which is critical for sustaining infection control efforts in healthcare settings.

The correct answer is B, "Pre-cleaning, leak testing, and manual cleaning," as these processes are essential for endoscope reprocessing. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, proper reprocessing of endoscopes is critical to prevent healthcare-associated infections (HAIs), given their complex design and susceptibility to microbial contamination. The initial steps of pre-cleaning (removing gross debris at the point of use), leak testing (ensuring the endoscope’s integrity to prevent fluid ingress), and manual cleaning (using enzymatic detergents to remove organic material) are foundational to the reprocessing cycle. These steps prepare the endoscope for high-level disinfection or sterilization by reducing bioburden and preventing damage, as outlined in standards such as AAMI ST91 (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment). Failure at this stage can compromise subsequent disinfection, making it a non-negotiable component of the process.

Option A (intermediate level disinfection and contact time) is an important step but insufficient alone, as intermediate-level disinfection does not achieve the high-level disinfection required for semi-critical devices like endoscopes, which must eliminate all microorganisms except high levels of bacterial spores. Option C (inspection using a borescope and horizontal storage) includes valuable quality control (inspection) and storage practices, but these occur later in the process and are not essential initial steps; vertical storage is often preferred to prevent damage. Option D (leak testing, manual cleaning, and low level disinfection) includes two essential steps (leak testing and manual cleaning) but is inadequate because low-level disinfection does not meet the standard for endoscopes, which require high-level disinfection or sterilization.

The emphasis on pre-cleaning, leak testing, and manual cleaning aligns with CBIC’s focus on adhering to evidence-based reprocessing protocols to ensure patient safety and prevent HAIs (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.4 - Implement environmental cleaning and disinfection protocols). These steps are mandated by guidelines to mitigate risks associated with endoscope use in healthcare settings.