An outbreak of Candida auris is suspected in the infection preventionist's (IP) facility. The IP'sinvestigation must be conducted in a standard method and communication is critical. Which first step is MOST important?
Conduct environmental cultures
Plan to prevent future outbreaks
Notify facility administration
Perform analytical studies
In an outbreak investigation,the first critical stepis tonotify facility administrationand other key stakeholders.This ensures the rapid mobilization of resources, coordination with infection control teams, and compliance with regulatory reporting requirements.
Why the Other Options Are Incorrect?
A. Conduct environmental cultures– Whileenvironmental sampling may be necessary, it isnot the first step. The outbreak must first be confirmed and administration alerted.
B. Plan to prevent future outbreaks–Prevention planning happens laterafter the outbreak has been investigated and controlled.
D. Perform analytical studies–Data analysis occurs after case definition and initial response measures are in place.
CBIC Infection Control Reference
APIC guidelines state thatthe first step in an outbreak investigation is confirming the outbreak and notifying key stakeholders.
A 2-yoar-old girl is admitted with a fractured tibia. At birth, she was diagnosed with congenital cytomegalovirus (CMV). Which of the following barrier precautions is appropriate for healthcare personnel caring for her?
Wear masks and gloves
Wear gloves when handling body fluids
No barrier precautions are needed
Use gowns, masks, gloves, and a private room
Standard Precautionsare sufficient forcongenital cytomegalovirus (CMV), which means thatgloves should be used when handling body fluids. CMV is primarily transmitted viadirect contact with saliva, urine, or blood.
Why the Other Options Are Incorrect?
A. Wear masks and gloves–Masks are not necessary unless performing high-risk aerosol-generating procedures.
C. No barrier precautions are needed–Gloves are required when handling bodily fluidsto prevent transmission.
D. Use gowns, masks, gloves, and a private room– CMV does not requireContact or Airborne Precautions.
CBIC Infection Control Reference
APIC guidelines state thatCMV transmission is prevented using Standard Precautions, primarily with glove use for body fluid contact.
An infection preventionist (IP) encounters a surgeon at the nurse’s station who loudly disagrees with the IP’s surgical site infection findings. The IP’s BEST response is to:
Report the surgeon to the chief of staff.
Calmly explain that the findings are credible.
Ask the surgeon to speak in a more private setting to review their concerns.
Ask the surgeon to change their tone and leave the nurses’ station if they refuse.
The scenario involves a conflict between an infection preventionist (IP) and a surgeon regarding surgical site infection (SSI) findings, occurring in a public setting (the nurse’s station). The IP’s response must align with professional communication standards, infection control priorities, and the principles of collaboration and conflict resolution as emphasized by the Certification Board of Infection Control and Epidemiology (CBIC). The “best” response should de-escalate the situation, maintain professionalism, and facilitate a constructive dialogue. Let’s evaluate each option:
A. Report the surgeon to the chief of staff: Reporting the surgeon to the chief of staff might be considered if the behavior escalates or violates policy (e.g., harassment or disruption), but it is an escalation that should be a last resort. This action does not address the immediate disagreement about the SSI findings or attempt to resolve the issue collaboratively. It could also strain professional relationships and is not the best initial response, as it bypasses direct communication.
B. Calmly explain that the findings are credible: Explaining the credibility of the findings is important and demonstrates the IP’s confidence in their work, which is based on evidence-based infection control practices. However, doing so in a public setting like the nurse’s station, especially with a loud disagreement, may not be effective. The surgeon may feel challenged or defensive, potentially worsening the situation. While this response has merit, it lacks consideration of the setting and the need for privacy to discuss sensitive data.
C. Ask the surgeon to speak in a more private setting to review their concerns: This response is the most appropriate as it addresses the immediate need to de-escalate the public confrontation and move the discussion to a private setting. It shows respect for the surgeon’s concerns, maintains professionalism, and allows the IP to review the SSI findings (e.g., data collection methods, definitions, or surveillance techniques) in a controlled environment. This aligns with CBIC’s emphasis on effective communication and collaboration with healthcare teams, as well as the need to protect patient confidentiality and maintain a professional atmosphere. It also provides an opportunity to educate the surgeon on the evidence behind the findings, which is a key IP role.
D. Ask the surgeon to change their tone and leave the nurses’ station if they refuse: Requesting a change in tone is reasonable given the loud disagreement, but demanding the surgeon leave if they refuse is confrontational and risks escalating the conflict. This approach could damage the working relationship and does not address the underlying disagreement about the SSI findings. While maintaining a respectful environment is important, this response prioritizes control over collaboration and is less constructive than seeking a private discussion.
The best response is C, as it promotes a professional, collaborative approach by moving the conversation to a private setting. This allows the IP to address the surgeon’s concerns, explain the SSI surveillance methodology (e.g., NHSN definitions or CBIC guidelines), and maintain a positive working relationship, which is critical for effective infection prevention programs. This strategy reflects CBIC’s focus on leadership, communication, and teamwork in healthcare settings.
An infection preventionist (IP) is informed of a measles outbreak in a nearby community. What is the IP’s FIRST priority when working with Occupational Health?
Isolate employees who have recently traveled to areas with measles outbreaks.
Reassign employees who are pregnant from caring for patients with suspected measles.
Verify that employees in high-risk exposure areas of the facility have adequate immunity to measles.
Set up a mandatory vaccination clinic in collaboration with Occupational Health and local public health partners.
When an infection preventionist (IP) is informed of a measles outbreak in a nearby community, the immediate priority is to protect healthcare workers and patients from potential exposure, particularly in a healthcare setting where vulnerable populations are present. Working with Occupational Health, the IP must follow a structured approach to mitigate the risk of transmission, guided by principles from the Certification Board of Infection Control and Epidemiology (CBIC) and public health guidelines. Let’s evaluate each option to determine the first priority:
A. Isolate employees who have recently traveled to areas with measles outbreaks: Isolating employees who may have been exposed to measles during travel is an important infection control measure to prevent transmission within the facility. However, this action assumes that exposure has already occurred and requires identification of affected employees first. Without knowing the immunity status of the workforce, this step is reactive rather than preventive and cannot be the first priority.
B. Reassign employees who are pregnant from caring for patients with suspected measles: Reassigning pregnant employees is a protective measure due to the severe risks measles poses to fetuses (e.g., congenital rubella syndrome risks, though measles itself is more about maternal complications). This action is specific to a subset of employees and depends on identifying patients with suspected measles, which may not yet be confirmed. It is a secondary step that follows assessing overall immunity and exposure risks, making it inappropriate as the first priority.
C. Verify that employees in high-risk exposure areas of the facility have adequate immunity to measles: Verifying immunity is the foundational step in preventing measles transmission in a healthcare setting. Measles is highly contagious, and healthcare workers in high-risk areas (e.g., emergency departments, pediatric wards) are at increased risk of exposure. The CBIC and CDC recommend ensuring that all healthcare personnel have documented evidence of measles immunity (e.g., two doses of MMR vaccine, laboratory evidence of immunity, or prior infection) as a primary infection control strategy during outbreaks. This step allows the IP to identify vulnerable employees, implement targeted interventions, and comply with occupational health regulations. It is the most proactive and immediate priority when an outbreak is reported in the community.
D. Set up a mandatory vaccination clinic in collaboration with Occupational Health and local public health partners: Establishing a vaccination clinic is a critical long-term strategy to increase immunity and control the outbreak. However, this requires planning, resource allocation, and coordination, which take time. It is a subsequent step that follows verifying immunity status to identify those who need vaccination. While important, it cannot be the first priority due to its logistical demands.
The first priority is C, as verifying immunity among employees in high-risk areas establishes a baseline to prevent transmission before reactive measures (e.g., isolation, reassignment) or broader interventions (e.g., vaccination clinics) are implemented. This aligns with CBIC’s focus on proactive risk assessment and occupational health safety during infectious disease outbreaks, ensuring a rapid response to protect the healthcare workforce and patients.
When conducting a literature search which of the following study designs may provide the best evidence of a direct causal relationship between the experimental factor and the outcome?
A case report
A descriptive study
A case control study
A randomized-controlled trial
To determine the best study design for providing evidence of a direct causal relationship between an experimental factor and an outcome, it is essential to understand the strengths and limitations of each study design listed. The goal is to identify a design that minimizes bias, controls for confounding variables, and establishes a clear cause-and-effect relationship.
A. A case report: A case report is a detailed description of a single patient or a small group of patients with a particular condition or outcome, often including the experimental factor of interest. While case reports can generate hypotheses and highlight rare occurrences, they lack a control group and are highly susceptible to bias. They do not provide evidence of causality because they are observational and anecdotal in nature. This makes them the weakest design for establishing a direct causal relationship.
B. A descriptive study: Descriptive studies, such as cross-sectional or cohort studies, describe the characteristics or outcomes of a population without manipulating variables. These studies can identify associations between an experimental factor and an outcome, but they do not establish causality due to the absence of randomization or control over confounding variables. For example, a descriptive study might show that a certain infectionrate is higher in a group exposed to a specific factor, but it cannot prove the factor caused the infection without further evidence.
C. A case control study: A case control study compares individuals with a specific outcome (cases) to those without (controls) to identify factors that may contribute to the outcome. This retrospective design is useful for studying rare diseases or outcomes and can suggest associations. However, it is prone to recall bias and confounding, and it cannot definitively prove causation because the exposure is not controlled or randomized. It is stronger than case reports or descriptive studies but still falls short of establishing direct causality.
D. A randomized-controlled trial (RCT): An RCT is considered the gold standard for establishing causality in medical and scientific research. In an RCT, participants are randomly assigned to either an experimental group (exposed to the factor) or a control group (not exposed or given a placebo). Randomization minimizes selection bias and confounding variables, while the controlled environment allows researchers to isolate the effect of the experimental factor on the outcome. The ability to compare outcomes between groups under controlled conditions provides the strongest evidence of a direct causal relationship. This aligns with the principles of evidence-based practice, which the CBIC (Certification Board of Infection Control and Epidemiology) emphasizes for infection prevention and control strategies.
Based on this analysis, the randomized-controlled trial (D) is the study design that provides the best evidence of a direct causal relationship. This conclusion is consistent with the CBIC's focus on high-quality evidence to inform infection control practices, as RCTs are prioritized in the hierarchy of evidence for establishing cause-and-effect relationships.
There are four cases of ventilator-associated pneumonia in a surgical intensive care unit with a total of 200 ventilator days and a census of 12 patients. Which of the following BEST expresses how this should be reported?
Ventilator-associated pneumonia rate of 2%
20 ventilator-associated pneumonia cases/1000 ventilator days
Postoperative pneumonia rate of 6% in SICU patients
More information is needed regarding ventilator days per patient
The standard way to reportventilator-associated pneumonia (VAP) ratesis:
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AI-generated content may be incorrect.
Why the Other Options Are Incorrect?
A. Ventilator-associated pneumonia rate of 2%– This does not use thecorrect denominator (ventilator days).
C. Postoperative pneumonia rate of 6% in SICU patients–Not relevant, as the data focuses onVAP, not postoperative pneumonia.
D. More information is needed regarding ventilator days per patient–The total ventilator days are already provided, so no additional data is required.
CBIC Infection Control Reference
APIC and NHSN recommend reporting VAP rates as cases per 1,000 ventilator days.
A patient with shortness of breath and a history of a tuberculin skin test (TST) of 15 mm induration was admitted to a semi-private room. The infection preventionist's FIRST action should be to
contact the roommate's physician to initiate TST.
review the patient's medical record to determine the likelihood of pulmonary tuberculosis (TB).
report the findings to the Employee Health Department to initiate exposure follow-up of hospital staff.
transfer the patient to an airborne infection isolation room and initiate appropriate isolation for tuberculosis (TB).
Before initiating airborne precautions, theinfection preventionist must first confirm the clinical suspicion of active TB.
Step-by-Step Justification:
Confirming Active TB:
Apositive tuberculin skin test (TST) alone does not indicate active disease.
A review ofchest X-ray, symptoms, and risk factorsis needed.
Medical Record Review:
Past TB history, imaging, and sputum testingare key to diagnosis.
Not all TST-positive patients require isolation.
Why Other Options Are Incorrect:
A. Contact the roommate's physician to initiate TST:Premature, asno confirmation of active TB existsyet.
C. Report findings to Employee Health for staff follow-up:Should occuronly after TB confirmation.
D. Transfer to airborne isolation immediately:Airborne isolation is necessaryonly if active TB is suspected based on clinical findings.
CBIC Infection Control References:
Peripherally inserted central catheter (PICC)-associated bloodstream infections (BSIs) have been increasing over the past four months. Which of the following interventions is MOST likely to have contributed to the increase?
Use of chlorhexidine skin antisepsis during insertion of the PICC
Daily bathing adult intensive care unit patients with chlorhexidine
Replacement of the intravenous administration sets every 72 hours
Use of a positive pressure device on the PICC
Peripherally inserted central catheter (PICC)-associated bloodstream infections (BSIs) are a significant concern in healthcare settings, and identifying factors contributing to their increase is critical for infection prevention. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the "Surveillance and Epidemiologic Investigation" and "Prevention and Control of Infectious Diseases" domains, which align with the Centers for Disease Control and Prevention (CDC) guidelines for preventing intravascular catheter-related infections. The question asks for the intervention most likely to have contributed to the rise in PICC-associated BSIs over four months, requiring an evaluation of each option based on evidence-based practices.
Option C, "Replacement of the intravenous administration sets every 72 hours," is the most likely contributor to the increase. The CDC’s "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (2017) recommend that intravenous administration sets (e.g., tubing for fluids or medications) be replaced no more frequently than every 72-96 hours unless clinically indicated (e.g., contamination or specific therapy requirements). Frequent replacement, such as every 72 hours as a routine practice, can introduce opportunities for contamination during the change process, especially if aseptic technique is not strictly followed. Studies cited in the CDC guidelines, including those by O’Grady et al. (2011), indicate that unnecessary manipulation of catheter systems increases the risk of introducing pathogens, potentially leading to BSIs. A change to a 72-hour replacement schedule, if not previously standard, could explain the observed increase over the past four months.
Option A, "Use of chlorhexidine skin antisepsis during insertion of the PICC," is a recommended practice to reduce BSIs. Chlorhexidine, particularly in a 2% chlorhexidine gluconate with 70% alcohol solution, is the preferred skin antiseptic for catheter insertion due to its broad-spectrum activity and residual effect, as supported by the CDC (2017). This intervention should decrease, not increase, infection rates, making it an unlikely contributor. Option B, "Daily bathing adult intensive care unit patients with chlorhexidine," is another evidence-based strategy to reduce healthcare-associated infections, including BSIs, by decolonizing the skin of pathogens like Staphylococcus aureus. The CDC and SHEA (Society for Healthcare Epidemiology of America) guidelines (2014) endorse chlorhexidine bathing in intensive care units, suggesting it should lower, not raise, BSI rates. Option D, "Use of a positive pressure device on the PICC," aims to prevent catheter occlusion and reduce the need for frequent flushing, which could theoretically decrease infection risk by minimizing manipulation. However, there is no strong evidence linking positive pressure devices to increased BSIs; if improperly used or maintained, they might contribute marginally, but this is less likely than the impact of frequent tubing changes.
The CBIC Practice Analysis (2022) and CDC guidelines highlight that deviations from optimal catheter maintenance practices, such as overly frequent administration set replacements, can increase infection risk. Given the four-month timeframe and the focus on an intervention’s potential negative impact, Option C stands out as the most plausible contributor due to the increased manipulation and contamination risk associated with routine 72-hour replacements.
Which of the following options describes a correct use of personal protective equipment?
Personal eyeglasses should be worn during suctioning.
Surgical masks should be worn during lumbar puncture procedures.
Gloves should be worn when handling or touching a cardiac monitor that has been disinfected.
Eye protection should be worn when providing patient care it at risk of spreading respiratory disease after unprotected exposure.
According toCDC and APIC guidelines, asurgical mask is requiredwhen performinglumbar puncturestoprevent bacterial contamination (e.g., meningitis caused by droplet transmission of oral flora).
Why the Other Options Are Incorrect?
A. Personal eyeglasses should be worn during suctioning–Incorrectbecauseeyeglasses do not provide adequate eye protection. Goggles or face shields should be used.
C. Gloves should be worn when handling or touching a cardiac monitor that has been disinfected–Not necessaryunless recontamination is suspected.
D. Eye protection should be worn when providing patient care after unprotected exposure– Eye protection should be usedbefore exposure, not just after.
CBIC Infection Control Reference
APIC states that surgical masks must be worn for procedures such as lumbar puncture to reduce infection risk.
An infection preventionist is reviewing employee health immunization policies. What is the recommendation for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) for a 55-year-old nurse who received all childhood vaccinations?
One dose of Tdap vaccine
Two doses of Tdap vaccine at least 14 days apart
Two doses of Tdap vaccine at least 28 days apart
No additional vaccination is recommended
The correct answer is A, "One dose of Tdap vaccine," as this is the recommended immunization for a 55-year-old nurse who received all childhood vaccinations. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, which align with recommendations from the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), adults who have completed a primary series of childhood vaccinations (typically 5 doses of DTaP or DTP) should receive a single booster dose of Tdap if they have not previously received it. This is especially critical for healthcare personnel, such as a 55-year-old nurse, due to their increased risk of exposure to pertussis and the need to protectvulnerable patients (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents). The Tdap vaccine, which protects against tetanus, diphtheria, and pertussis, is recommended once between ages 11-64, with a preference for administration in early adulthood (e.g., 19-26 years) or as soon as feasible for older adults, including this 55-year-old nurse, to ensure immunity against pertussis, which wanes over time. For individuals aged 65 and older, Tdap is still recommended if not previously received, though Tdap is preferred over Td (tetanus and diphtheria only) for healthcare workers to address pertussis risk.
Option B (two doses of Tdap vaccine at least 14 days apart) and Option C (two doses of Tdap vaccine at least 28 days apart) are not standard recommendations for adults with a complete childhood vaccination history. Multiple doses are typically reserved for individuals with incomplete primary series or specific high-risk conditions, not for this scenario. Option D (no additional vaccination is recommended) is incorrect because, even with a complete childhood series, a Tdap booster is advised for healthcare workers to maintain protection, especially given the nurse’s occupational exposure risks (CDC Immunization Schedules, 2024). After receiving the Tdap booster, a Td booster every 10 years is recommended to maintain tetanus and diphtheria immunity, but the initial Tdap dose is the priority for this nurse.
The recommendation for one Tdap dose aligns with CBIC’s emphasis on evidence-based immunization policies to prevent transmission of vaccine-preventable diseases in healthcare settings (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.1 - Collaborate with organizational leaders). This ensures the nurse is protected and contributes to herd immunity, reducing the risk of pertussis outbreaks in the healthcare environment.
