The CBIC Certified Infection Control Exam Study Guide (6th edition) emphasizes that effective process improvement relies on a structured, data-driven approach that includes baseline assessment, intervention, and ongoing evaluation. A key principle of quality improvement is that outcomes must be measured before and after changes are implemented in order to determine whether an intervention resulted in improvement.

Option D is the correct “EXCEPT” choice because limiting outcome measurement to only after changes are implemented prevents meaningful comparison and makes it impossible to determine effectiveness. Without baseline data, improvements cannot be quantified, trends cannot be assessed, and unintended consequences may go unrecognized. The Study Guide stresses that baseline measurements are essential to evaluate process performance and to support evidence-based decision-making.

Options A, B, and C are all appropriate and expected activities. Direct observation helps identify workflow gaps and variation in practice. Inclusion of central supply and operating room leadership ensures multidisciplinary engagement and operational insight. Conducting a literature review supports alignment with current evidence, standards, and best practices for disinfection and sterilization.

For the CIC® exam, it is important to recognize that continuous measurement throughout the improvement cycle—not only after implementation—is required for successful standardization and sustainability of infection prevention practices.