Practice exam 1, Practice Exam 2, Practice Exam 3

What is the bacteria that cause plague?

Yersinia pestis, maintain their existence in a cycle involving rodents and their fleas.

Can discrete data be categorical or non-categorical?

Yes

HICPAC Categorization Scheme for Recommendations Category 1B

A strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms, or an accepted practice (e.g., aseptic technique) supported by low to very low-quality evidence.

Describe Bacteroides fragilis?

Anaerobic gram negative rod which is normal flora of the oral cavity and GI and genital tracts.

59. Examples of high-level disinfectants are: 1) Glutaraldehyde 2) Hydrogen peroxide 3) Enzymatics 4) 70 percent ethyl alcohol a. 1,3 b. 1,2 c. 2,3 d. 1,

Answer: 1, 2 1) Glutaraldehyde 2) Hydrogen peroxide Rationale: Semi-critical items minimally require high-level disinfection using chemical disinfectants. Glutaraldehyde, hydrogen peroxide, orthophthaladehyde, improved hydrogen peroxide, peracetic acid with hydrogen peroxide, and chlorine-based products are approved by the U.S. Food and Drug Administration and are dependable high-level disinfectants provided the factors influencing germicidal procedures are met.

45. Which of the following helps to prevent the aerosolization of spores during dusting? 1) A damp paper towel 2) A chemically treated cloth or dust mop 3) A microfiber cloth or dust mop 4) A dry cotton wash cloth a. 1,2 b. 2,3 c. 1,4 d. 2, 4

Answer: 2, 3 2) A chemically treated cloth or dust mop 3) A microfiber cloth or dust mop Rationale: Dust contains fungal spores. To capture dust without aerosolizing spores, dusting should be performed using a cloth or dust mop that is chemically treated or made of microfiber. Dusters should never be shaken. Reference: APIC Text, 4th edition, Chapter 107

117. Immunizations recommended for all HCP include: 1) Human papillomavirus vaccine (HPV) 2) Shingles (herpes zoster) vaccine 3) Influenza vaccine 4) Tetanus, diphtheria, and pertussis (Tdap) vaccine a. 1,4 b. 2,3 c. 3,4 d. 2,4

Answer: 3, 4 3) Influenza vaccine 4) Tetanus, diphtheria, and pertussis (Tdap) vaccine Rationale: The ACIP recommends that all HCP regardless of their age receive a single dose of Tdap if they have not been previously vaccinated. ACIP also recommends that all HCP receive seasonal influenza vaccine annually. References: Shefer A, Atkinson W, Friedman C, et al.

91. The critical care classes have 48 new students. There are eight males. The ratio of females to males is: a. 1:5 b. 5:1 c. 6:1 d. 1:6

Answer: 5:1 Rationale: A ratio is a relationship between two numbers of the same kind expressed as "a to b" or a:b. It provides a comparison of two quantities. The ratio of females to males is 40:8 or 5:1. Reference: APIC Text, 4th edition, Chapter 13

45. The Director of the Infection Prevention Department has assigned one of her IPs to cofacilitate in a root cause analysis of an adverse event in collaboration with the Performance Improvement team. The IP plans to use process improvement tools and techniques during the analysis. Which of the following methods would best outline the possible causes of the event? a. Brainstorming b. Affinity diagrams C. Fishbone diagram d. Pareto chart

Fishbone diagram Rationale: A fishbone diagram (also called,al 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. See Figure PE1-1 for an example Chapter 16

Describe Enterococcus faecalis?

Gram positive cocci, commensal bacterium of GI tract. Formerly classified as part of the group D Streptococcus system.

A FMEA can be used to?

Identify potential system failures or errors before they occur.

If inhalation anthrax is suspected, what diagnostic test can confirm anthrax?

If inhalation anthrax is suspected, chest X-rays or computed tomography scans can confirm if the patient has mediastinal widening or pleural effusion, which are X-ray findings typically seen in patients with inhalation anthrax.

109. Which agency or agencies has regulatory authority over some aspects of healthcare facility design, construction, and renovation related to Infection Prevention and Control? 1) Occupational Health and Safety Administration (OSHA) 2) National Institute for Occupational Safety and Health (NIOSH) 3) National Institutes of Health (NIH) 4) Centers for Disease Control and Prevention (CDC) a. 1 b. 1,2 c. 2, 3, 4 d. 1, 2, 3, 4

OSHA Rationale: OSHA is the only agency listed above that has regulatory authority over any aspect of healthcare facility design, construction, and renovation. OSHA has set regulations for engineering controls related to bloodborne pathogens and to isolation of suspected or confirmed cases of Tuberculosis in an airborne isolation room. Reference: Occupational Health and Safety Administration (OSHA

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) Rationale: 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. The standard also requires that each worker assigned to wear a respirator receive a fit test before wearing the respirator in the workplace and perform a seal check with each use. Chapter 100

21. The reservoir of microbes of pathogens present in potable water and its delivery network include: 1) Staphlococci 2) Pseudomonas spp. 3) Nontuberculous Mycobacteria 4) Arthrobacter spp. a. 1,2 b. 2,3 c. 1,4 d. 2,4

Pseudomonas spp. Nontuberculous Mycobacteria Rationale: Disruption of water utility systems during construction or renovation can disturb the biofilm present in water delivery pipes and pose a threat to patients. Microbes present in potable water and its delivery network include gram-negative bacteria, e.g., Legionellae and Pseudomonas spp, nontuberculous Mycobacteria, protozoa, and fungi. Reference: APIC Text, 4th edition, Chapter 117

How do you confirm anthrax?

The only way to confirm a diagnosis of anthrax is to either test directly for B. anthracis in a sample (blood, skin lesion swab, spinal flUid, or respiratory secretions) or measure antibodies or toxin in blood.

Susceptible patients and personnel to measles may be given a live attenuated measles-containing vaccine within 72 hours of exposure to modify disease. Does this vaccine does not modify the need for isolation precautions or furlough?

This vaccine does not modify the need for isolation precautions or furlough. Susceptible patients and HCP who are immunocompromised should be given immunoglobulin to modify their disease. Immunoglobulin does not modify the need for isolation or furlough.

What are the symptoms of Tularemia?

Tularemia is a rare infectious disease that typically attacks the skin, eyes, lymph nodes and lungs. Tularemia — also called rabbit fever or deer fly fever — is caused by the bacterium Francisella tularensis.

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 Rationale: Urinary tract infections (LITIs) 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. Reference: Chapter 33

What is a Type 1 error?

Type I error occurs when one rejects the null hypothesis (Ho) - when it is true This is also called a false-positive result (we incorrectly conclude that the research hypothesis is true when in fact it is not).

73. A major hurricane is forecast for your area and you need to plan for the possible contamination of potable water that is supplied to your facility. Which of the following should be included in your planning? a. You should have at least one day's worth of back up water supplies available b. You will need one liter per day of drinking water for all patients and healthcare workers c. All back up water must be stored on site for easy access d. You will need at least 25 gallons of water per patient per day to maintain care

You will need at least 25 gallons of water per patient per day to maintain care Rationale: In the event of a disaster, it is critical to ensure that there is a reliable supply of water available for drinking and for patient care activities. Individuals in the facility will need at least 2 liters of drinking water per day per person, and additional water will be needed for bathing, flushing toilets, dialysis, cooking, and other activities. It is estimated that a facility will need 25 gallons of water per patient per day to maintain these \ patient care activities. Water may be stored on-site or off-site but it must be accessible in the event of an emergency. Reference: APIC Text, 4th edition, Chapter 119

10. While rounding in an ambulatory care center, an IP discovers that healthcare personnel have been using single-dose vials of lidocaine for multiple patients. She informs the clinic manager that the practice must end immediately. Which of the following statements about SDVs should the IP include in her explanation to the clinic manager? 1) SDVs lack antimicrobial preservatives 2) Inappropriate use of SDVs can lead to contamination 3) A needleless access device (spike) must be applied when reusing an SDV 4) All medications from an SDV must be prepared in a pharmacy a. 1 ,2 b. 2, 3 c. 3, 4 d. 2, 4

a. 1 and 2 1) SDVs lack antimicrobial preservatives 2) Inappropriate use of SDVs can lead to contamination Rationale: The CDC's guidelines call for medications labeled as "single dose" or "single use" to be used for only one patient. This practice protects patients from life-threatening infections that occur when medications get contaminated from unsafe use. Vials labeled by the manufacturer as "single dose" or "single use" should only be used for a single patient. These medications typically lack antimicrobial preservatives and can become contaminated and serve as a source of infection when they are used inappropriately. Reference: Chapter 48

27. The IP is planning an educational program for the nursing staff. The IP knows that in order to increase retention and motivate the nurses to change practice behaviors, she should do which of the following? 1) Assume a facilitator role 2) Utilize monologues to provide critical information 3) Incorporate an interactive approach 4) Use a computer-based learning module a. 1,3 b. 1, 4 c. 2,3 d. 1,2

a. 1, 3 1) Assume a facilitator role 3) Incorporate an interactive approach Rationale: To increase retention and motivate the learner to change practice behaviors, the educator should assume a facilitator role, limit monologues or lectures, and opt for more interactive classroom approaches. A rule of thumb for the active/passive ratio is a minimum of 60/40. This mix of activities and presentation methods will also help to hold the adult learner's interest. Providing a safe, low-risk, nonthreatening learning environment can facilitate class interaction. Reference: Chapter 3

12. The annual education budget for the Infection Prevention Department is $1,650.00. In October, the Infection Prevention Manager allocated 20 percent of the department education budget towards resources for the annual flu shot program. However, in November, the financial report indicates that only 15 percent was spent. How much of the budgeted amount remains unspent? a. $330.00 b. $247.50 c. $82.50 d. $66.00

c. $82.50 Rationale: A budget is a quantitative expression of a plan for a defined period of time. The manager's budget for the flu shot program is 20 percent of $1,650 (1,650 x 0.20), or $330. However, only 15 percent (1,650 x 0.15), or $247.50 was spent. This leaves a remainder of $82.50. Reference: Chapter 1

81. The IP is performing the annual evaluation of the infection prevention and control program. Components of this document should include: 1) The achievements and activities of the program 2) Results from the latest accreditation survey 3) Stress the value of the program to the organization 4) Satisfy the legal requirements for reporting infections a. 1,2 b. 2,3 c. 1,3 d. 3, 4

c. 1, 3 1) The achievements and activities of the program 3) Stress the value of the program to the organization Rationale: An annual evaluation of the IP program is important to outline achievements and activities of the program and describe support requirements. The value of the infection prevention program to the organization should be emphasized, along with patient outcomes and cost savings. Reference: APIC Text, 4th edition, Chapter 1

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 HAls consistent with those used for inpatient settings b. HAI comparison with external benchmarks for all sites c. Development of communication networks between sites, hospitals, and health departments d. Standardized infection prevention policies and procedures

c. Development of communication networks between sites, hospitals, and health departments Rationale: The establishment Of communication networks and collaboration at all levels of the outpatient sites is essential to implement infection prevention practices more effectively and efficiently. For outpatient sites, the use of measurement and operational definitions for HAls can be challenging due to the lack of standardized definitions. There are limited external benchmarks for HAls in ambulatory care, and HAI rates are often internally compared over time to establish a benchmark. Infection prevention policies and procedures should be specific to each setting. Chapter 48

119. The use of influenza vaccines in school-aged children to decrease the number of cases in the community uses the principle of: a. Innate immunity b. Passive immunity c. Herd immunity d. Epidemic immunity

c. Herd immunity Rationale: Herd or community immunity describes a situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated are offered some protection because the disease has little opportunity to spread within the community. Reference: APIC Text, 4th edition, Chapter 10

2. A classic sign of measles is: a. Kaposi sarcoma b. Stiff neck c. Koplik spots d. Bull's-eye rash

c. Koplik spots Rationale: Measles is a highly communicable viral illness with prodromal fever, conjunctivitis, coryza, cough, and small spots with white or bluish-white centers on an erythematous base on the buccal mucosa. These small spots are called Koplik spots.

50. Managing infection prevention outcomes, analyzing variance trends, and evaluating corrective actions taken to reduce infection risks are components of: a. Case management b. Utilization review c. Performance improvement d. Medical review

c. Performance improvement Rationale: Performance improvement is measuring the output of a particular process or procedure, then modifying the process or procedure to increase the output, increase efficiency, or increase the effectiveness of the process or procedure. Performance improvement is an ongoing cycle that focuses on patient clinical outcomes and customer satisfaction and service. Measuring performance determines program effectiveness and efficiency and whether proactive approaches or retrospective analysis of high-risk processes can further improve the infection prevention program. Reference: APIC Text, 4th edition, Chapter 16

19. 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)

c. Provide information on antimicrobial usage and resistance patterns in the community Rationale: The surveillance of antimicrobial resistance is an essential first step in identifying priority areas for managing antimicrobial use from an IP perspective versus a pharmacy or cost-containment perspective. An antibiogram simplifies multiple patients' antimicrobial sensitivity information at an institution into a single number for pathogens of interest in an effort to monitor trends emerging in drug resistance. An antibiogram is a useful tool for the IP to determine the status of strategies in place to reduce MDROs. Reference: APIC Text, 4th edition, Chapter 26

108. Which interventions are designed to limit the spread of respiratory illnesses in outpatient settings? a. Sterilization monitors b. Aseptic technique c. Respiratory hygiene/cough etiquette d. Symptom-based evaluation

c. Respiratory hygiene/cough etiquette Rationale: Although all options are used to prevent infections, respiratory hygiene/respiratory etiquette measures are specifically designed to limit the spread of respiratory diseases such as influenza. Respiratory hygiene/cough etiquette is an element of Standard Precautions that highlights the need for prompt implementation of infection prevention measures at the first point of encounter with the facility/ambulatory settings (e.g., reception and triage areas).

Unused sharps are not ________________ but must be disposed of in a sharps container because of the high risk of puncture injuries and inability to know that the object was not contaminated

infectious waste

What am I? Clinical manifestations are nonspecific, but high fever, diarrhea, and hyponatremia are often distinctive. Infection has been linked to drinking water distribution systems of acute care and extended care facilities

Legionella pneumophila

29. The air exchanges in the decontamination area of Sterile Processing should be negative with a minimum of how many air exchanges per hour? a. Six b. Eight c. Nine d. Ten

Ten Rationale: The ventilation of the decontamination area should be negative air pressure (pulls air into the work area) with 10 air exchanges/hour and all air exhausted to the outside atmosphere. Reference: APIC Text, 4th edition, Chapter 106

113. Seventy-five patients were admitted to the Medical-Surgical ICU. Forty were on the surgical service and 35 were on the medical service. Fifteen patients developed a HAI with MRSA. Nine of the patients with MRSA infection were on the surgical service. There were 230 patient days in the ICU for the surgical patients in January, and 325 patient days for medical patients. Whatwas the MRSA attack rate for patients on the medical service? a. 8 percent b. 2 percent c. 17 percent d. 15 percent

1 7 percent Rationale: An attack rate is a special form of incidence rate. It is not'truly a rate, but a proportion. It is the proportion of persons at 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 and is used almost exclusively for epidemics or outbreaks of disease where a specific population is exposed to a disease for a limited period of time. The attack rate equals the number of new cases of disease (for a specified time period) divided ,by the population at risk for the same time period multiplied by 100. Attack rate is the same as incidence rate, except that attack rates are always' expressed as cases per 100 populations or as a percentage. The MRSA attack rate for this scenario is 6 ÷ 35 x100 =17 percent Reference: APIC Text, 4th edition, Chapter 13 - Use of

36. - Training on the use of PPE for environmental service employees must include: 1) When to wear PPE 2) The limitations of each type of PPE 3) Maintenance of PPE 4) The cost of PPE a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

1) When to wear PPE 2) The limitations of each type of PPE 3) Maintenance of PPE Rationale: The PPE training program must include the following: 1. When PPE is worn 2. What PPE to wear 3. How to don, remove, adjust, and wear each type of PPE 4. Limitations of each type of PPE 5. Care, maintenance, useful life, and storage or disposal of pPE 6. Written certification indicating that the employee has received and understood the training Reference: APIC Text, 4th edition, Chapter 107

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 workers' compensation benefit? a. Provide enough information to prove or disprove the employee's claim b. Notify the facility's attorney immediately c. Review the workers' compensation system in place d. Perform a root cause analysis to investigate

48. Q Review the workers' compensation system in place Rationale: Disease that results from occupational exposure usually is eligible for compensation if the occupational exposure is the sole cause of disease; the occupational exposure is one of several causes of the disease; the occupational exposure aggravates a pre-existing disease (e.g., asthma); 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 provide the necessary follow-up. IPs should be familiar with the workers' compensation system in place within their country. Reference: APIC Text, 4th edition, Chapter 100

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 Rationale: Multidisciplinary teams are a valuable tool in deploying a quality focused culture or process. Successful teams increase problem solving and efficiency, raise morale and productivity, use integrative rather than imposed solutions, increase acceptance of the solution, and tap the potential in people and their fundamental knowledge of the process. Reference: APIC Text, 4th edition, Chapter 16

33. Scabies is transmitted through: a. Sharing combs and brushes b. Handling books or magazines after a person infested with scabies c. Direct contact with infested skin d. Scabies mites crawling from person to person

Direct contact with infested skin Rationale: Transfer of parasites commonly occurs through prolonged direct contact with infested skin and also during sexual contact. Transfer from undergarments and bedclothes occurs only if these have been contaminated by infested persons immediately beforehand. People with crusted scabies syndrome are highly contagious because of the large number of mites present in the exfoliating scales.

20. The microbiology lab calls the IP with a CSF Gram stain result. From an infection prevention and control standpoint, the most concerning result would be: a. Gram-negative rods b. Gram-positive cocci in pairs c. Acid-fast bacilli d. Gram-negative diplococci

Gram-negative. diplococci Rationale: Growth of oxidase-positive colonies and Gram-negative diplococci with the right clinical context provides a presumptive identification of N. meningitidis. Reference: APIC Text, 4th edition, Chapter 87 - Neisseria

127. You are presenting an in-service to the Environmental Services group in your facility. Which of the following recommendations should you make related to mopping of patient rooms? a. Standard mori heads should be disinfected with a phenolic weekly b. Standard mop heads should be laundered daily c. Mop water should be changed after two hours of use d. Mop water should be changed after use on six patient rooms

Standard mop heads should be laundered daily. Rationale: Although mopping of patient rooms with a low-level disinfectant is an effective method of cleaning, there are protocols that should be followed to avoid increasing the bio-burden in rooms. Mop heads should be decontaminated by being laundered daily and mop water should be changed after use in three to four patient rooms or no more than one hour of use. Reference: CDC Guideline for Disinfection and Sterilization

How is the water disinfected for Legionella pneumophila

Superheating and flushing with hyper-chlorination as a short term approach to terminating an outbreak. Copper-silver ionization has been validated for long-term systemic disinfection. Chlorine dioxide is a promising alternative disinfection method. Disinfection of the facility's water system should be considered if there is evidence of a prior case(s) of healthcare associated legionellosis, greater than 30 percent colonization of distal sites in the water system, or prospective surveillance for legionellosis detects a healthcare-associated case.

Cryptococcal meningitis is caused by.

The fungus Cryptococcus neoformans and is found in soil around the world. Cryptococcosis is believed to be acquired by inhalation and it comes on slowly, over a few days to a few weeks. India ink will stain the polysaccharide capsule of C. neoformans, and C. neoformans meningitis is characterized by low glucose in the CSF and predominant lymphocytes.

72. The epidemiologic triangle" model for disease causation does not include: a. Agent b. Host c. Time d. Environment

Time Rationale: The "epidemiological triangle" Model of disease consists of three elements: host, agent, and environment. The host is the human, and the environment consists of all external factors associated with the host. The agent may be a bacteria, virus, fungus, protozoan, helminth, or prion. In this model of dynamic interaction, a change in any component alters the existing equilibrium. Change may increase or decrease the frequency of disease. Although this model is particularly useful in the study of infectious diseases, it is also applicable to other conditions. Reference: Chapter 10

23. A patient is admitted with watery diarrhea and abdominal cramps. The food history interview reveals that the patient consumed raw oysters recently. Which of the following organisms is the most likely cause? a. Yersinia b. Clostridium difficile c. Vibrio d. Campylobacter

Vibrio Rationale: Vibrio gastroenteritis is caused by eating undercooked or raw seafood, such as fish and shellfish. Reference: APIC Text, 4th edition, Chapter 83

107. Which of the following would be appropriate for a graph displaying C. difficile infections? a. X axis labeled with the months of the year b. X axis labeled with the number of cases each month c. Y axis labeled with the months of the year d. Y axis labeled with the days of the month of April

X axis labeled with the months of the year Rationale: Graphs are a method of showing quantitative data using a system of coordinates. A well-constructed graph consists of two sets of lines that intersect at right angles. Each axis (line) has a scale measurement and a label. Time (year, month, quarter, day, etc.) is usually represented on the horizontal (x) axis. The vertical (y) axis usually reflects the frequency of occurrence of an event (e.g., the number of cases of disease) or the proportion (e.g., percent, cases per 1,000 patient days) with the event. Each graph should be simple and self-explanatory. Reference: APIC Text, 4th edition, Chapter 10 - General

65. Which of the following is the primary method to prevent influenza? a. Annual vaccination b. Hand washing c. Droplet Precautions d. Promotion of respiratory hygiene/cough etiquette

a. Annual vaccination Rationale: Vaccination i the primary method for preventing influenza and its complications. Recommendations for vaccine and antiviral drug use are published regularly by the ACIP: All persons aged 6 months and older should be vaccinated annually unless specific medical contraindications exist. References: APIC Text, 4th edition, Chapter 82

29. The purpose of the annual infection prevention program risk assessment is to: a. Determine goals and objectives for the following year b. Describe support requirements of the program c. Outline the achievements and activities of the program d. Document the facility's risks of infection

a. Determine goals and objectives for the following year Rationale: An annual risk assessment must be performed to determine goals and objectives for the infection prevention program. These should be based on the institution's strategic goals and institutional data and findings from the previous year's activities. Infection prevention resources and data systems needs should be evaluated in the context of these goals and objectives. Reference: APIC Text, 4th edition, Chapter 1-a.

112. Which of the four clinical variables that determine the probability of infection would the IP be targeting when reviewing preoperative chlorhexidine gluconate (CHG) bathing instructions that have been given to the preoperative patient population? a. Inoculurn of bacteria b. Virulence of bacteria c. Adjuvants in the microenvironment d. Efficiency of host defenses

a. Inoculum of bacteria Rationale: The probability of infection is determined by the interaction of four clinical variables: (1) inoculum of bacteria, (2) virulence of bacteria, (3) adjuvants in the microenvironnnent, and (4) efficiency of host defenses. The risk for SSI is related to the number of microorganisms contaminating the wound. A preoperative antiseptic shower or bath decreases skin microbial colony counts. Clinical studies have documented that multiple applications of 2 or 4 percent CHG using a standardized protocol results in high skin surface concentrations sufficient to inhibit/kill skin colonizing flora, including MRSA. Reference: APIC Text, 4th edition, Chapter 37

124. The IP is called to the day care center for a possible outbreak of Hepatitis A. The Public Health Nurse is assisting her in investigating the outbreak. Prophylactic administration of immunoglobulin to the day-care workers and non-infected children would be an example of: a. Passive immunity b. Active immunity c. Herd immunity d. Nonspecific immunity

a. Passive immunity Rationale: Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15 to 50 days).. HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease. Current CDC guidelines recommend that persons who have recently been exposed to HAV and who have not been vaccinated previously be administered a single dose of single-antigen Hepatitis A vaccine or lmmunoglobulin (IG) (0.02 mL/kg) as soon as possible, within 2 weeks after exposure. IG is an example of passive immunity, which is provided when a person is given antibodies to a disease rather than producing them through his or her own immune system. Reference: APIC Text, 4th edition, Chapter 103 - Immunization

22. A pediatric patient has been diagnosed with pediculosis. What is the most appropriate follow-up to prevent it from spreading to other patients or healthcare professionals? 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 Rationale: In addition to placing the patient on Contact Precautions, patient bedding, clothing, and waterproof personal items should be washed at high temperature. Reference: APIC Text, 4th edition, Chapter 96

44. The Infection Prevention Manager is analyzing the department's overall performance. The ratio of output to input will produce a measure of the department's: a. Productivity b. Effectiveness c. Quality control d. Throughput

a. Productivity Rationale: Productivity is the ratio of output to inputs in production. It is an average measure of the efficiency of production. Efficiency of production means production's capability to create incomes, which are measured by subtracting real input value from real output value. References: APIC Text, 4th edition, Chapter 1

89. A patient is admitted with skin and soft tissue injury from a cat bite. The most likely organism involved in the infection would be: a. Pasteurella b. Pseudomonas c. E. coli d. Mycobacterium

a. pasteurella Rationale: Cat bites are more likely to become infected (28 to 80. percent) than dog bites (3 to 18 percent), and Pasteurella spp. (primarily P. multocida) is the most common isolate from dogs as well as cats. Pasteurella spp. is highly pathogenic, inducing progressive soft tissue infections with a typically rapid onset (often < 24 hours). Streptococci, staphylococci, Moraxella spp., Corynebacterium spp., and Neisseria spp. were the next most common aerobic isolates derived from cat bites. Reference: AP1C Text, 4th edition, Chapter 92

38. Which of the following organisms is most likely to be associated with contaminated disinfectants? a. Pseudomonas species b. Hepatitis C c. Clostridium difficile d. Cryptosporidium parvum

a. pseudomonas species Rationale: Although disinfectants are formulated to kill microbes, they can, become contaminated during use and can spread the contaminating microbe in the environment. Species of the genus Pseudomonas have been isolated in over 80 percent of contaminated products. To prevent contamination of disinfectants, the products should not be diluted unless specified by the manufacturer, workers who prepare and use disinfectant solutions should be trained on the common ways that these solutions become contaminated, and disinfectant solutions should be stored per the manufacturer's recommendations.

48. When a test has a higher specificity than sensitivity, it means the test: a. Will be more accurate when predicting who is ill b. A negative result will be more accurate than a positive c. A positive result will be more accurate than a negative d. It should only be done as a secondary testing procedure to rule out disease

b. A negative result will be more accurate than a positive Rationale: Sensitivity (also called the true positive rate) measures the proportion of actual positives that are correctly identified as such (e.g., the percentage of sick people who are, correctly identified as having the condition). Specificity (sometimes called the true negative rate) measures the proportion of negatives that are correctly identified as such (e.g., the percentage of healthy people who are correctly identified as not having the condition). Specificity = TN/(TN+FP) Therefore, a test with 100 percent specificity correctly identifies all patients without the disease. Reference: APIC Text, 4th edition, Chapter 13

87. Viral infections are difficult to treat because: a. Viruses can suspend their metabolism in the presence of antivirals b. Viruses use the host's cells to replicate c. Synthesis of enzymes that inactivate the drug d. Viruses may block viral mRNA transcription

b. Viruses use the host's cells to replicate Rationale: It is difficult to designing safe and effective antiviral drugs because viruses use the host's cells to replicate. This makes it challenging to find targets for the drug that would interfere with the virus without also harming the host organism's cells. Chapter 25

15. Which of the following statements are true regarding consent to immunization? 1) Some states allow personal belief exemptions 2) Federal regulations require Informed consent 3) All states allow medical exemptions for persons with medical contraindications to vaccination 4) Vaccine recipients must receive Vaccine Information Statements (VISs) a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

c. 1, 3,4 1) Some states allow personal belief exemptions 3) All states allow medical exemptions for persons with medical contraindications to vaccination 4) Vaccine recipients must receive Vaccine Information Statements (VISs) Rationale: HCP are required by the National Childhood Vaccine Injury Act (NCVIA) to provide a copy of the Vaccine Information Statement to either the adult recipient or to the child's parent/legal representative. All states allow medical exemptions for persons who have medical contraindication to vaccination. Most states allow religious exemptions and some allow philosophical/personal belief exemptions. There is no federal requirement for informed consent relating to immunization. Reference: Chapter 100

91. The CDC lists 18 drug-resistant threats to the United States. These threats are categorized based on level of concern: urgent, serious, and concerning. Which of the following belong to the "Urgent" threat category? 1) Neisseria gonorrhea 2) Vancomycin-resistant Staphylococcus aureus 3) Drug-resistant Tuberculosis 4) Clostridium difficile a. 1,2 b. 2,3 c. 1,4 d. 3,4

c. 1, 4 Rationale: Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. These are high-consequence threats due to the significant risks identified across several criteria. These threats have the potential to become widespread and require urgent public health attention to identify infections and limit transmission.

51. What recommendation should an IP give regarding mask use by a staff member who has documented immunity to varicella (chickenpox) while caring for a patient who is on Airborne Precautions for varicella (chickenpox)? a. Wear an N95 respirator whenever entering the room b. Wear a regular surgical mask whenever entering the room c. No mask is needed d. The patient should don a surgical mask

c. NO mask is needed Rationale: According to the HICPAC 2007 Guideline for Isolation Precautions, there are no recommendations for HCP who are immune to measles and chickenpox (varicella) to wear respiratory PPE. There are also no recommendations for susceptible HCP to wear a surgical mask versus an N95 respirator when caring for patients with measles or Chickenpox (varicella). References: APIC Text, 4th edition, Chapter 29 -

26. A measles exposure from a patient in a clinic was identified and an exposure workup was initiated. A staff exposure was defined as "nonimmune 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 not have the same room or face-to-face contact. How many HCP were at risk of developing measles because of this exposure? a. 4 b. 45 c. 1 d. 48

c.. 1 Rationale: Measles is a highly contagious febrile exanthern. In most immunocompetent individuals, measles is a self-limited condition with a distinct clinical prodrome of cough, coryza, and conjunctivitis followed by a rnorbilliform skin eruption. Measles is more severe in young, malnourished, and immunocompromised persons. Even healthy individuals may experience complications, however, such as otitis media, bronchopneumonia, encephalitis, and laryngotracheobronchitis. Because measles is so highly contagious; healthcare facilities need to be prepared to safely care for measles patients. Measles immunity (natural or vaccinated) among HCP and use of proper isolation guidelines and postexposure protocols-need to be established to minimize the potential for healthcare-associated transmission of measles. According to the definition of staff exposure, only one healthcare worker was nonimmune and had more than 5 minutes of same-room contact or face-to-face contact with the index patient. Susceptible personnel who have been exposed to an individual with measles should be furloughed (relieved from healthcare activities) from the fifth to the 21st day after exposure, regardless of whether they received measles vaccine or immunoglobulin after exposure or until 4 days after development of rash. Personnel who develop measles should be furloughed until they have had their rash for 4 days. Chapter 86

42. When using heat to treat a room for bed bugs, the temperature must be: a. 85°F or 29°C for one hour b. 110°F or 43°C for 90 minutes c. 125°F or 51°C for two hours d. 118°F or 48°C for one hour

d. 118°F or 48°C for one hour Rationale: Bed bugs are challenging to eradicate. Some pest control firms utilize specialized heating equipment to de-infest furnishings, rooms, and entire dwellings. The procedure involves heating up the infested item or area to temperatures lethal to bed bugs. Portable heaters and fans are used to treat the room with high heat (118°F or 48°C for one hour). Reference: APIC Text, 4th edition, Chapter 107

74. Measures of dispersion to consider for surveillance reporting include which of the following? a. Rates b. Ratios and proportions c. Percentiles d. Range and standard deviation

d. Range and standard deviation Rationale: Measures of dispersion are important for describing the spread of the data or its variation around a central value (mean). Commonly used measures of dispersion are the range, deviation, variance, and standard deviation. The range is the difference between the highest value in a data set and the lowest value. The standard deviation is a measure of how much the data are scattered around the mean and is the square root of the sample variance. Reference: Chapter 11

The randomized clinical trails (RCT) design __________ bias and provides the best evidence for direct causal relationships between the experimental factor and the outcome

minimizes bias and provides the best evidence for direct causal relationships between the experimental factor and the outcome

A thorough RCA determines:

(1) human and other factors; (2) the process or system involved; (3) underlying causes and effects of the process; and (4) the risks and potential contributions to failure or adverse results

5. Which of the following aid in the diagnosis of pseudomembranous colitis (PMC)?. 1) Colonoscopic biopsy of lesions 2) Raised antibody levels in blood to Clostridium difficile toxin 3) Positive blood culture for Clostridium difficile 4) Stool assays for Clostridium difficile a. 1,2 b. 2,3 c. 3,4 d. 1,4

1) Colonoscopic biopsy of lesions 4) Stool assays for Clostridium difficile Rationale: Pseudomembranous colitis (PMC) is an acute colitis characterized by the formation of an adherent inflammatory membrane (pseudomembrane) overlying sites of mucosa] injury. Clostridium difficile infection is responsible for the majority of cases of PMC and for as many as 20 percent of cases of antibiotic-induced diarrhea without colitis. The method of choice fore establishing the diagnosis is done by stool assays for C. difficile toxins or by colonoscopy. Reference: APIC Text, 4th edition, Chapter 72 -

27. Which of the following must be documented when using soaking solutions for cleaning instruments? 1) Monitoring the temperature of the solution 2) Monitoring the room temperature 3) Monitoring the humidity of the room 4) The time the instruments soaked a. 1,2 b. 2, 4 c. 3,4 d. 1,4

1) Monitoring the temperature of the solution 4) The time the instruments soaked Rationale: The temperature of the soaking solution should be monitored and documented to ensure that the temperature of the cleaning solution meets the requirement of the cleaning solution's written IFU. The time the instruments are soaked should also be recorded. Reference: APIC Text, 4th edition, Chapter 106 - Sterile

6. 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

1, 2, 3 Not Haemophilus species Rationale: Body piercing activities can transmit infectious diseases. Bacterial infections may result from improper initial piercing technique or from poor hygiene. The organisms involved in most earlobe-piercing infections are often considered normal skin flora, including Staphylococcus and Streptococcus species. Higher ear piercings in the ear cartilage have been associated with more pathogenic organisms, including Pseudomonas species. Multiple cases of atypical Mycobacterium infections after piercing have been reported. Mastitis due to Mycobacterium abscesses has been reported after a nipple piercing; Mycobacterium flavescens has been reported after an eyebrow piercing, and Mycobacterium chelonae has been reported after a navel piercing. There are case reports of infective endocarditis that required treatment with intravenous antibiotics, and in some cases surgical intervention to replace heart valves; the infections resulting from navel, earlobe, and nipple piercings. There has also been a case report of tetanus after a naval piercing. Reference: APIC Text, 4th edition, Chapter 123 Body Piercing, Tattoos, and Electrolysis

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 in the facility a. 1, 2, 4 b. 1, 2, 3 c. 2, 3, 4 d. 1, 3, 4

1, 2, 3 It is NOT a broad assessment of all risks identified in the facility. Rationale: The risk assessment should be tailored to the risks in specific to a facility and must include identification of risks based on the facility's geographic location, community, and population served as well as the types of services the facility offers. The annual risk assessment should take into account the previous year's goals and objectives and whether the facility met the targets associated with those goals. Reference: APIC Text, 4th edition, Chapter 1

134. Which of the following parameters affect(s) the effectiveness of ethylene oxide (ETO) sterilization? 1) Gas concentration 2) Temperature 3) Relative humidity 4) Exposure time a. 1,2 b. 1, 3, 4 C. 1, 2:3, 4 d. 1,4

1, 2, 3,4 1) Gas concentration 2) Temperature 3) Relative humidity 4) Exposure time Rationale: Ethylene oxide (ETO) sterilization is affected by four parameters. The concentration of gas should be between 450 and 1200 mg/L, the temperature range should be between 37 and 63°C, the relative humidity should be between 40 and 80 percent, and the exposure time should be between and 6 hours.

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

1, 2, 4 Rationale: Performance measures focus on outcomes or processes. They are used for internal improvement purposes, intra- or inter-organizational comparisons, and by various external entities for making decisions about care. Performance measure should be designed to address improvement that is likely to have a significant impact to the health of a specified population. The measure should consistently track the events within an organization or across organizations and over time. The resulting data should be easily understood by the end-users (e.g., staff, facility leaders). Chapter 17

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 bedbound patients for no more than 5 days a. 1, 3, 4 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3

1, 2, 4 Rationale: The risk of infection related to vascular access for hemodialysis varies with the type of vascular access used. Risk for bacteremia increases sevenfold in patients with a dialysis catheter compared to those with a primary arteriovenous (AV) fistula. It is recommended that an AV fistula be created and used for long-term hemodialysis treatment because of the lower incidence of infection. If an AV fistula cannot be established, an AV graft is the next preferred type of access. Because of infection risk, creation of the fistula in the upper arm is preferred over the thigh. For acute hemodialysis, where access for less than 3 weeks duration is anticipated, vascular access may be obtained using a noncuffed or cuffed catheter. However, if a catheter must be used for access for longer than 3 weeks, a tunneled, cuffed venous catheter should be used. The preferred insertion site is the right internal jugular. Because there is a greater incidence of central venous thrombosis and stenosis when the subclavian is used, subclavian access should be used only when jugular options are not available and permanent vascular access is not required. In addition, tunneled cuffed catheters should not be placed on the same side as a maturing AV access if possible. Femoral catheters should be placed only in bedbound patients only with good exit site care and should be, left in place for no more than 5 days because of associated infection rates. Reference: APIC"Text, 4th edition, Chapter 39

69. Inadequate refrigeration of food may permit the growth of potentially harmful microbes. Interventions to prevent the 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 preventive maintenance of freezer and refrigerator a. 1, 2, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 3, 4

1, 2,4 Rationale: Interventions to prevent the growth of microbes include: • When selecting/purchasing equipment for cooling or freezing, compare features that best meet the intended use, including operating range (e.g., an automatic defrost cycle can damage temperature-sensitive items), size, location of use, cleanable surfaces, durability, and maintenance needs. . • Provide accurate temperature monitoring for refrigerators and freezers; an alarm system may be required (e.g., blood bank refrigerator) or desired. • Establish a method to record temperature on a regular basis (e.g., visualize and document daily or observe an automated recording chart each shift); include action to take if reading is not in the acceptable range. • Schedule routine 'monitoring of refrigerator and freezer alarms where applicable. • Test accuracy of thermometers; calibration may be required (e.g., blood bank, tissue freezer) by. using standard regulations and/or recommendations. • Schedule and perform regular preventive maintenance of all freezers and refrigerators; include air vents, gaskets, cooling coils, and fans. • Walk-in refrigeration units may experience a condensation point if the building dehumidification is inadequate, resulting in mold proliferation. • Provide training for personnel in reciognizing and implementing safe maintenance of refrigerators to include appropriate cleaning methods. Reference: APIC Text; 4th edition, Chapter 112

3. Which of the following rules should be followed when collecting a stool sample for C. difficile testing? 1) Stool sample should be freshly passed within 1-2 hours 2) 10-20rnL. of formed stool should be collected 3) Stool should be passed into a clean, dry container 4) Specimens should be obtained before antimicrobial agents have been administered a. 1,2 b. 2,3 c. 1,3 d. 1,4

1, 3 1) Stool sample should be freshly passed within 1-2 hours 3) Stool should be passed into a clean, dry container Rationale: The accuracy of all tests depends on proper specimen handling and transport. The following rules should be followed when collecting samples for C. difficile testing: • Stool samples should be freshly passed within 1-2 hours • 10-20 mL of watery, soft, or unformed stool should be collected • Stool should be passed into a clean, dry container Reference: APIC Text, 4th edition, Chapter 72

75. A case of healthcare-associated Mycobacterium chelonae respiratory infection has been identified in a patient. Of the following exposures that the patient had in the facility, which should be investigated as a potential source of the infection? 1) Bronchoscopes 2) Dialysis 3) Hydrotherapy pool 4) Ice from tap water used during surgery a. 1 b. 1, 3 c. 1, 3, 4 d. 1, 2, 3, 4

1, 3 Rationale: Mycobacterium chelonae belongs to the family of nontuberculous mycobacteria (NTM) classified in the rapidly growing mycobacteria (RGM), Runyon group IV. M chelonae are ubiquitous in the environment and have been isolated from both natural and potable freshwater sources, soil, contaminated solutions, and reptiles. The organism can grow in distilled and unsupplemented water. Likely sources of healthcare-related exposure may occur from bronchoscopes that were processed with tap water or from exposure to a hydrotherapy pool. Reference: CDC Guidelines for Environmental Infection

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 HAls as mandated by state/local public health requirements -

1, 3, 4 Rationale: Surveillance has been defined as ,the "ongoing collection, collation, and analysis of data and the ongoing dissemination of information to those who need to know so that action can be taken." It is an essential component of an effective infection prevention program. Surveillance programs should measure outcomes of healthcare, processes of healthcare, and selected events of importance to the organization. Routine or random, undirected microbiological culturing of air, water, and environmental surfaces in healthcare facilities is not recommended. . Reference: APIC Text, 4th edition, Chapter 11

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 pariicipants 4) Assessing the educational needs of the attendees a. 1, 2, 3 b. 1, 3, 4 c. 2, 3, 4 d. 1, 2, 4

1,2,3 Rationale: Program evaluation is a systematic method for collecting, analyzing, and using information to assess the effectiveness and efficiency of the educational offering. Specific program elements that must be evaluated include appropriateness of program design, adequacy of teaching and instructional resources, and the knowledge, skills, and attitudes learned by the participants. Needs assessments identify deficiencies in knowledge, skills, or attitude and should be conducted prior to the development of the program. Reference: APIC Text, 4th edition, Chapter 3

63. An early-level (novice) IP in your department has set a goal of advancing to achieve middle-level (proficient) competency within the next year. Which of the following activities would be the most appropriate to include on her personal development plan for the year: 1) Nominating herself for the President-elect position of the local APIC chapter 2) Taking the Certification in Infection Control exam within six months 3) Requesting information about a Master of Science in Epidemiology degree 4) Learning the basics of CAUTI surveillance a. 1 b. 1,2 c. 1, 2, 3 d. 1, 2, 3, 4

1,2,3 1) Nominating herself for the President-elect position of the local APIC chapter 2) Taking the Certification in Infection Control exam within six months 3) Requesting information about a Master of Science in Epidemiology degree Rationale: APIC has created a competency model to help guide the advancement of infection preventionists in the field. The three levels of competency are early-level (novice), middle-level (proficient), and advanced level (expert). The competency levels can be used to guide goal setting activities as part of the IP's personal development plan. Middle-level competencies include being Certified in Infection Control, considering a`h advanced degree in the field, and being active in the local APIC chapter by serving in a -leadership position. Chapter 2

9. 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

1,3 1) Improper handling, cleaning, and rinsing of the instruments 3) Gloves and powder Rationale: Endophthalmitis is an inflammatory condition of the intraocular cavities (aqueous and/or vitreous humor) usually caused by infection. Noninfectious (sterile) 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 an inflammation. Gloves, especially those with powder, can also cause inflammation of the eye during surgery. Only a few organisms can penetrate the intact epithelium of the conjunctiva or cornea. Among these are Neisseria gonorrhoeae, Neisseria meningitidis, Streptococcus pneumoniae, Listeria monocytogenes, and Corynebacterium diphtheriae. For all others, a breach in the protective epithelial barrier or mucous membranes must occur. Once the intact epithelium has been breached (e.g., by trauma, or by insertion/removal of a contact lens), any microorganism gaining entrance can cause disease Reference: APIC Text, 4th edition, Chapter 63 - Ophthalmology Services

Key recommendations from the CDC for respiratory hygiene/cough etiquette in ambulatory settings include:

1. Post signs at entrances with instructions to patients with symptoms of respiratory infection to: 2. Cover their mouths/noses when coughing or sneezing 3. Use and dispose of tissues 4. Perform hand hygiene after hands have been in contact with respiratory secretions 5. Provide tissues and no-touch receptacles for disposal of tissues 6. Provide resources for performing hand hygiene in or near waiting areas 7. Offer masks to coughing patients and other symptomatic persons upon entry to the facility 8. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care

Why is it difficult to describe the epidemiology of disease transmission after tattooing and body piercing procedures?

1. There have not been uniform licensure requirements thus it is generally limited to bloodborne diseases identified by the healthcare system. 2. The licensure varies greatly by state. Regulations may address the age of the client, client histories, sterilization processes, single-use items, apprenticeships / training, and bloodborne pathogens training.

Learning is facilitated when:

1. There is immediate application for the learning. 2. They participate actively in the learning process. 3. They can practice new skills or test new knowledge before leaving a learning session 4. When participants are involved in their learning, rather then being passive observers, they are more likely to master the information or concepts presented, apply them to their practice, and retain the information presented

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 marinum. Which of the following is the 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

100. 0 No further follow-up is needed Rationale: M. marinum is a bacterium found in water and may be the cause of wound infections. Infection with M. marinum is not transmissible, and infection with non-tuberculosis mycobacteria is not notifiable. No further infection control follow-up is needed.

101. Examples of efforts to improve patient safety in the healthcare setting include: 1) Encouraging patients to ask their healthcare providers if they have 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

101. 0 1, 2, 3 Rationale: In healthcare organizations, surveillance, reporting, and analysis are the foundation of risk prevention programs, but targeted interventions must be deployed if patient safety programs are to be successful in reducing harm from medical errors and other adverse events. The Agency for Healthcare Research and Quality recommends that all healthcare organizations focus on the following infection prevention initiatives: 1. Improving hand hygiene 2. Utilizing barrier precautions to prevent transmission of infection 3. Prudent antibiotic use to reduce C. difficile and VRE 4. Preventing urinary tract infections S. Preventing central venous catheter-related bloodstream infections 6. Preventing VAP 7. Preventing SSIs Medication errors are also common in healthcare and are addressed in TJC's list of sentinel events: "Any patient death, paralysis, coma, or other major permanent loss of function associated with a medication error." A culture of safety must prevent punitive reactions to mistakes, and staff members must feel confident that if they speak out about risk, their leaders will respond. Providers involved in medical errors must know that leaders will look beyond the obvious and drill down until the root causes of accidents and errors are found and that they will routinely evaluate systems and processes during any accident investigation. Reference: APIC Text, 4th edition, Chapter 18

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

102. cip 2, 4 Rationale: The CDC recommends using the subclavian site rather than a jugular or a femoral site in adult patients to minimize infection risk for nontunneled central venous catheter placement.

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

103. 0 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 Rationale: The first step is to verify that the patient actually has the disease. If the patient does live confirmed varicella-zoster, the occupational health nurse should work this up as an exposure and exclude the employee from work. References: APIC Text, 4th 'edition, Chapter 100

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 itover 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 biohazard-labeled container d. She should remove the top by pulling it over her head and then discard it in the trash

104. e She should remove the scrub top by using scissors to cut it off and discard it in a biohazard-labeled container Rationale: A scrub top that has been thoroughly soiled with blood should be removed immediately. If the scrub top is soiled through the top layer, there is potential for further exposure through contamination of mucus membranes if the employee pulls it over her head. She should use scissors to carefully cut off the top. Reference: APIC Text, 4th edition, Chapter 111

105. There was contamination of a healthcare facility's potable water system with sewer water and there is high concern for the presence of Cryptosporidium. Which of the following should you recommend for corrective decontamination of the system? a. Use chlorination to disinfect the system b. Use high-temperature flushing to disinfect the system c. Use fluoridation to flush the system d. Use ultraviolet light to flush the system

105. 0 Use high-temperature flushing to disinfect the system Rationale: If there is contamination of the potable water system with sewer water in a facility then it is necessary to flush the system. A variety of methods can be used to accomplish this and they may be used in combination, if necessary. As Cryptosporidium is highly resistant to chlorine and there is suspected contamination with this protozoa in this scenario,. you would have to minimally recommend the use of high-temperature flushing to disinfect the system.

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. Quaternary ammonium compound c. Phenolic d. Bleach

106e. B leach Rationale: Many disinfectants are inactivated by blood and other organic matter. If the spill is small, it can be cleaned and disinfected in one step by pouring the disinfectant directly on the spill and cleaning up after the appropriate contact time for the disinfectant has been reached. If the spill involves a higher concentration of microorganisms, such as a large body fluid spill or a blood spill in a laboratory, absorbent material can be placed over the spill until all of the fluid is absorbed. The disinfectant solution can be poured over the spill and the absorbent material until both are thoroughly soaked with the disinfectant for the designed contact time. Then the spill site is cleaned. Absorbent powders that solidify liquids are recommended for cleaning large spills. Occupational Safety & Health Administration (OSHA) stipulates that blood and body fluid spills be decontaminated with one of the following: an EPA registered disinfectant effective against HBV and HIV, a tuberculocidal disinfectant, or an appropriate dilution of household bleach (5.25 to 6.15 percent sodium hypochlorite solution). If the spill occurs on a nonporous surface, a 1:100 dilution of household bleach (one part household bleach plus 99 parts tap water or 0.25 cup of bleach in a gallon of water) is a highly effective disinfectant and is the least expensive. A 1:10 dilution of household bleach (one part household bleach plus nine parts water or 1.5 cups of bleach in a gallon of water) is required for porous surfaces and large spills. Large quantities of blood may inactivate the higher concentration of bleach. Higher concentrations of bleach may also be damaging or corrosive to surfaces. Reference: APIC Text, 4th edition, Chapter 107

108. Which of the following quality concepts will identify a pattern of observation points above and below the mean level? a. Fishbone diagram b. Run chart c. Pareto chart d. Process flow chart

108. Q Run chart Rationale: Run charts are epidemiological tools used to identify how process specifications change over time. For example, if the organization examines the number of HAls occurring within a hospital over a given period of time, clinicians will record each monthly value and graph the values, creating a chart that looks at trends and averages. Run charts allow for the mean or average to be determined and show changes in the mean/average. Run charts also demonstrate special cause variation when there is a steady pattern of observation points falling above or below the mean/average line in an equal pattern. Reference: APIC Text, 4th edition, Chapter 16

80. All of the 72 patients in a chronic hemodialysis center were tested for Hepatitis C virus (HCV). Eight of the patients were identified as HCV positive. What is the prevalence? a. 0.9 percent b. 9 percent C. 1 percent d. 11 percent

11 percent Rationale: A prevalence rate is the proportion of persons in a population with a particular disease or attribute at a specific point in time (point prevalence) or over a specified time period (period prevalence). Prevalence depends on the duration of disease. The prevalence rate equals the number of existing cases of disease from a specified interval or point in time divided by the population at risk for same time period multiplied by a constant (k). k = A constant used to transform the result of division into a uniform quantity so that it can be compared with other, similar quantities. A whole number (fractions are inconvenient) such as 100, 1,000, 10,000, or 100,000 is usually used (selection of k is usually made so that the smallest rate calculated has at least one digit to the left of the decimal point) or is determined by accepted practice (the magnitude of numerator compared with denominator). This prevalence rate is calculated as: 8 ÷ 72 x 100 = 11 percent Reference: APIC Text, 4th edition, Chapter 13

110. You are the IP in an ambulatory surgery center. During rounds, you discover that staff are using a single bag of saline to prepare saline flushes for multiple patients. Your immediate response is: a. Clarify that saline bags must be labeled with time of use and discarded within 24 hours b. Explain that single dose bottles of sterile water should be used to flush IVs c. -Remove the bag and send a follow-up email to the staff explain your actions d. Remove the bag and teach staff how to follow safe injection practices

110. Remove bag and teach staff how to follow safe injection practices Rationale: Unsafe injection practices put patients and healthcare providers at risk of infectious and non-infectious adverse events and have been associated with a wide variety of procedures and settings. Use fluid infusion and administration sets for one patient only and dispose of appropriately after use. Do not use bags or bottles of IV solution as a common source of supply for multiple patients. Chapter 64

111. An outbreak of Hepatitis C 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 compliance with recommended hand hygiene practices. Which practice is the most likely cause of the outbreak? a. Use of a single-dose mediation vial for more than one patient b. Poor hand hygiene practices c. Contamination of medication through the rubber stopper d. Inadequate cleaning and disinfection of endoscopes

111. 0 Use of a single-dose medication vial for more than one patient Rationale: Vials that are labeled as single-dose or single-use should be used for a single patient and single case /procedure/injection. There have been multiple outbreaks resulting from healthcare personnel using single dose or single-use vials for multiple patients. Even if a single-dose or single-use vial appears to contain multiple doses or contains more medication than is needed for a single patient, that vial should not be used for more than one patient nor stored for future use on the same patient. Reference: APIC Text, 4th edition, Chapter 110

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

113. 3, 4 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 Rationale: The IP will need to divide the number of spinal fusion infections for each surgeon by the number of spinal fusion surgeries performed by each surgeon. Chapter 21

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 recommended 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

114. Establish a method to recognize spills or leaks Rationale: Blood/body fluid (e.g., from specimens due to spill or leak) may contaminate transport system pathways (e.g., pneumatic tube system), receiver stations, transport carts, dumbwaiters, or elevators. Disruption caused by these spills can delay specimen transport and processing until the area is cleaned and disinfected. Personnel may also be exposed to bloodborne pathogens, other microbes (e.g., sputum specimen, tissue specimen), or chemicals (pharmaceuticals; preservatives such as formaldehyde). Establish a method to recognize spills or leaks; include communication protocol (e.g., notification to sender, system shutdown, alternative methods of transport), cleaning and decontamination, retrieval of "stuck" items, and restoration of system. Reference: APIC Text, 4th edition, Chapter 112

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

115. Legionella and Aspergillus Rationale: The risk of HAls increases significantly when hospitals are undergoing construction and renovation. Dust particles contaminated with bacteria and fungi are dispersed and pose a health risk for patients, staff, and visitors. Construction-related HAls are primarily caused by fungi, and to a lesser extent by bacteria. The most common etiological agent is Aspergillus, in particular, A. fumigatus, A. flavus, A. niger, and A. terreus. A. fumigatus is considered the most pathogenic species and is responsible for more than 90 percent of all Aspergillus infections. The most common group of bacteria associated with construction-related nosocomial infections are Legionella species, including L. pneumophila. Legionella bacteria have been isolated from soil and dust but are more often associated with aquatic environments. Typical water sources in hospitals supporting colonization with Legionella bacteria are cooling towers, evaporative condensers, heated potable water systems, and heating and air conditioning systems. During construction and renovation processes, water systems are often disrupted. Potable water can become contaminated with Legionella when the water supply is restored. The introduction of contaminated soil into the plumbing system, as well as optimized growth conditions for bacteria in stagnant water, may increase the number of Legionella bacteria. Chapter 11

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

116. Indicated a propagated source of infection Rationale: An epidemic curve gives a graphical display of the numbers of incident cases in an outbreak or epidemic plotted over time. The form of the resulting distribution of cases can be used to propose hypotheses on the nature of the disease and its mode of transmission. A propagated source means that infections are transmitted from person to person in such a way that cases identified cannot be attributed to agent(s) transmitted from a single source. Propagated (continuing) source cases occur over a longer period than in common source transmission. Explosive epidemics resulting from person-to-person transmission may occur (e.g., chickenpox). If secondary and tertiary cases occur, intervals between peaks usually approximate average incubation period. Reference: APIC Text, 4th edition, Chapter 12

117. What is the term for an unexpected occurrence involving death or serious physical or psychological injury, or the risk there of? a. Error b. Adverse event c. Near miss d. Sentinel event

117. Sentinel event Rationale: According to The Joint Commission, a sentinel event is an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase "or the risk thereof" includes any process variation for which a recurrence would cacry a significant chance of a serious adverse outcome. Such events are called sentinel because they signal the need for immediate investigation and response. Chapter 18

119. A patient in has been diagnosed with Legionnaires' disease that was possibly acquired during his stay in the hospital. What is the recommended firs t response to this incident? a. All water sites in the healthcare facility to which the patient was exposed should be cultured for L. pneumophlla b. The patient should be placed on respiratory isolation until 24 hours after treatment has started c. The water system should be superheated and flushed immediately d. All patients should immediately be provided with bottled water for drinking

119. All water sites in the healthcare facility to which the patient was exposed should be cultured for L. pneumothila Rationale: If there is suspicion of healthcare-associated L. pneumophila, the water system should be tested first to determine whether the microbe is present. Chapter 84

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

120. Learner outcomes in measurable terms using action verbs Rationale: Instructional objectives include specific actions the learner will perform as a result of instruction. There is no single correct method or style, but properly written learning objectives describe the learner outcomes in measureable terms and use action verbs such as discuss, describe, or demonstrate. Statements that communicate the intent of the curriculum and directions and plans for the educational session (A and B) are more appropriate for learning goals. Measures of changes, and growth in the learner (D) are used for evaluation of the learning program. Reference: APIC Text, 4th edition, Chapter 3

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

121. Physical removal of visible dirt, organic material, and debris Rationale: Accumulation of dust, soil, and microbial contaminants on environmental surfaces in healthcare facilities is not only aesthetically displeasing, but evidence indicates that it also plays a major role in the spread of HAls. Studies have shown that many microorganisms survive on surfaces for long periods. The key to cleaning and disinfecting environmental surfaces is the use of friction to physically remove visible dirt, organic material', and debris, thereby removing microorganisms.

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. latrogenic CJD c. Spontaneous CJD d. Mutational CJD

129. 0 latrogenic CJD Rationale: CJD is one of several neurologically degenerative diseases caused by a group of protein particles that are infectious by nature of their ability to replicate in the central nervous system and interrupt crucial neuron functioning. CJD and other prion diseases with demonstrated transmissibility remain a concern for the healthcare community because of their inherent resistance to traditional disinfection/sterilization methods and devastating clinical outcomes. Prion diseases occur sporadically in nature, by familial transmission (gene mutation), iatrogenically, and by ingestion of abnormal prions as in the case of the bovine encephalopathies. In this instance, the CJD developed as a result of medical treatment so it is termed iatrogenic. Reference: APIC Text, 4th edition, Chapter 73

130. List the following diseases in order of resistance of the disease agents to disinfection and sterilization, from high resistance to low resistance. 1) Staphylococcus aureus 2) Clostridium difficile 3) Creutzfeldt-Jakob Disease 4) Polio a. 1, 2, 3, 4 b. 2, 3, 4, 1 c. 3, 4, 2, 1 d. 3, 2, 4, 1

130. 3, 2, 4, 1 Creutzfeldt-Jakob Disease Clostridium difficile Polio Staphylococcus aureus Rationale: Microbes and other disease causing agents such as prions have . differing resistance to disinfection and sterilization. Prions are the most resistant and special reprocessing is required for instruments that have come in contact with infectious tissue of a person with Creutzfeldt-Jakob Disease. Spore-forming microbes are less resistant than prions but sterilization is require to remove these agents from medical instruments. Non lipid viruses such as Poliovirus and small viruses require intermediate-level disinfection and are more resistant than lipid-viruses or larger viruses. Vegetative bacteria such as Staphylococcus aureus have the lowest level of resistance to disinfection and sterilization.

132. What is the positive predictive value of the following data? a. 97.0 percent b. 92.5 percent c. 96.2 percent d. 99.4 percent

132. 0 97.1 percent Rationale: 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 test True positive,(TP) False positive (FP) Negative test Fels negative (FN) True negative (TN) Positive predictive value = TPATP + FP) The positive predictive value for this question is calculated as follows: 100 ÷ (100 + 3) = 0.97 or 97 percent Reference: APIC Text, 4th edition, Chapter 13

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

133. Decolonization of MRSA-positive patients prior to surgery Rationale: Prevention strategies in healthcare infection prevention are wide ranging and depend on the disease in question and what information is available to the practitioner. Prevention strategies to reduce the risk of transmission, including barrier precautions; immunizations of HCP; and cleaning, sterilization, and disinfection are designed to prevent the occurrence of disease and, therefore, form primary prevention, measures. Current decolonization-protocols using intranasal mupirocin and chlorhexidine body washes are effective for reducing MRSA colonization in surgical patients. The purpose of this treatment is to prevent SSIs in the individual patients. It is not designed to prevent the spread of MRSA to other patients. Reference: APIC Text, 4th edition, Chapter 10

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 settings 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 individual 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

2, 3 2) All paid and unpaid persons working in healthcare settings who have the potential for exposure to infectious Materials 3) Any individual who has the potential to acquire or transmit infectious agents during the course of his or her work in healthcare Rationale: According to the CDC, paid and unpaid personnel, as well as contracted workers or workers employed outside the healthcare organization (such as emergency medical service personnel) are included in the term HCP. Also included are laboratory and autopsy personnel as well as researchers and volunteers who may potentially be exposed to infectious agents. Reference: APIC Text, 4th edition, Chapter 100

40. A patient has been admitted to a healthcare facility with Neisseria meningitidils and placed on Droplet Precautions. When can the patient be removed from Droplet Precautions? a. After three consecutive CSF cultures are negative for N. meningitidis b. After the signs and symptoms of meningitis have resolved c. 24 hours after initiation of effective therapy d. The patient should remain on Droplet Precautions for the duration of the hospital stay

24 hours after initiation of effective therapy Rationale: The patient must remain on Isolation Precautions for 24 hours after appropriate antimicrobial therapy has been initiated. Reference: APIC Text, 4th edition, Chapter 29 - Isolation

77. All of the 72 patients in a chronic hemodialysis center were tested for Hepatitis C virus (HCV). Eight of the 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 percent b. 3.1 percent c. 13.8 percent d. 7.2 percent

3.1 percent Incidence rate in this scenario: 2 ÷ 64 x 100 = 3.125 percent Rationale: 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 (k). k = A constant used to transform the result of division into a uniform quantity so that it can be compared with other, similar quantities. A whole number (fractions are inconvenient) such as 100, 1,000, 10,000, or 100,000 is usually used (selection of k is usually Made so that the smallest rate calculated has at least one digit to the left of the decimal point) or is determined by accepted practice (the magnitude of numerator compared with denominator). The numerator for this scenario is 2—the number of new cases. The denominator would be the number of patients who are at risk for developing HCV, which would be 64. Patients already diagnosed with HCV would not be included. Reference APIC Text, 4th edition; Chapter 13

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 100,000 565 ÷ 1, 800,000 x 100,000 = 31.38 Rationale: A mortality rate is the measure of the frequency of death in a defined population during a specified time (usually a year). The crude mortality rate measures the proportion of the population dying each year from all causes. The cause-specific mortality rate measures mortality from a specified cause for a population. Mortality rate = x/y x k Where: x = The number of people in a defined population during a specified interval of time who (1) die of any cause (crude rate) or (2) die of a specified cause (cause-specific rate) y = Estimated population at midyear (i.e., July); crude rates use 1000 or 100,000 k = Usually an assigned value of 1,000 when calculating crude rates: 100,000 is used for cause-specific rates The cause-specific mortality rate for this scenario is calculated as follows: 565 ÷ 1, 800,000 x 100,000 = 31.38 We round to 31 and state that the cause-specific mortality rate is 31 per 100,000. Reference: APIC Text, 4th edition, Chapter 13

46. Which of the following is not an infection prevention objective of an occupational health program? a. Contain costs by preventing infectious diseases that result in absenteeism and disability 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

46. 43 Educate patients about the principles of infection prevention Rationale: The healthcare organization's administration, medical staff, and other HCP need to support the infection prevention objectives of an occupational health program. These objectives are to (1) educate personnel about the principles of infection prevention and their individual responsibility for infection prevention, (2) collaborate with the Infection Prevention Department in monitoring and investigating potentially harmful infectious exposures and outbreaks, (3) provide care to personnel for work-related illnesses or exposures, (4) identify work-related infection risks and institute appropriate preventive measures, and (5) contain costs by preventing infectious diseases that result in absenteeism and disability. Reference: APIC Text, 4th edition, Chapter 100

52. C. difficile spores can survive in the environment for: a. 24 months b. 3 months c. 5 months d. 12 months

5 months Rationale: CDI has emerged as a major pathogen of healthcare-associated infections. Multiple outbreaks caused by strains with high mortality rates have been reported. The organism produces spores in feces. Surfaces contaminated with feces become a potential reservoir of spores, which can survive in the environment for 5 months.

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

51. Plush Rationale: Strategies to minimize pediatric infection risk from toys include: • Practice of hand hygiene by patients before and after handling toys • 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. • Use of new toys Chapter 42

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 multidrug-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

52. The average amount of time that elapsed between receiving reports from the lab about patients with multidrug-resistant infections and placing those patients on appropriate Isolation Precautions Rationale: The quality of the infection prevention program should be assessed routinely by evaluating customer satisfaction, appropriateness, efficacy, timeliness, availability, effectiveness, and efficiency. The average amount of time that elapsed between receiving reports from the lab about patients with multidrug-resistant infections and placing those patients on appropriate Isolation Precautions relates to timeliness of initiating appropriate interventions. Therefore, it can be used as a quality measure for the program. Reference: APIC Text, 4th edition, Chapter 1

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. CD4

54. 0 Western blot Rationale: Rapid HIV tests can offer a result in 15 minutes. A negative rapid test is reported as a definitive negative HIV test. A reactive test result needs to be confirmed with standard serologic tests. The most commonly used laboratory test for diagnosis of HIV infection is the serologic detection of antibodies to the virus. The standard serologic test consists of a screening enzyme immunoabsorbent assay (EIA) followed by a confirmatory Western blot (WB). In a patient with a positive EIA test, the test should be repeated. In a patient with a repeatedly positive EIA, test, a confirmatory WB is performed. These serologic assays show sensitivity and specificity rates of 99.9 percent. Chapter 81

55. Which is an example of actions taken during the Study phase of the "Plan, Do, Study, Act" Performance Improvement Model? a. Identifying goals for the project b. Performing staff education sessions c. Trending and benchmarking of data collected d. Tweaking the program based on result

55. Trending and benchmarking of data collected Rationale: TJC makes clear in the Infection Control and Prevention Standards that organizations should align the plan with the goal of improving infection rates. The organization must collect and display data to frontline staff about how well the organization actually achieves rate reduction. Data may include steps to increase staff influenza vaccination rates, reduce bloodstream infection and urinary catheter rates, and reduce rates of VAP. During the study phase of the cycle, data display, Benchmarking, and trending become essential. Chapter 16

58. Which of the following must be reprocessed by high-level disinfection? a. Non-critical items b. Semi-critical items c. Critical items d. Non patient-care items

58. Semi-critical items Rationale: High-level disinfection must be used for processing of semi-critical items. These are items that will-come into contact with non-intact skin or mucous membranes. High-level disinfection will inactivate all vegetative organisms but some spores may remain. High-level disinfection can be carried out by Pasteurization or by immersion in high-level disinfectants. *Reference: APIC Text, 4th edition, Chapter 106 - Sterile

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

59. 03,4 Rationale: Endoscopes should be stored in a manner that protects them from contamination. When storing the endoscope, hang it in a vertical position to facilitate drying (with caps, valves, and other detachable components removed as per manufacturer instructions). Reference: APIC Text, 4th edition, Chapter 55

Susceptible HCP who have been exposed to an individual with measles should be furloughed (relieved from healthcare activities) from the?

5th-21st day after exposure, regardless of whether they received measles vaccine or immunoglobulin after exposure or until 4 days after development of their rash. HCP who develop measles should be furloughed until they have had their rash for 4 days.

53. On September 1, there were 30 surgical patients in the hospital. Two of these were postop patients with SSIs. A total of 75 surgeries were performed in September. Six additional SS's 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 because 2 were SSI and that took time thus they are not new... Rationale: 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 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 September 1, the numerator to calculate the incidence rate in this scenario is 6. Reference: APIC Text, 4th edition, Chapter 13

91. What is the acceptable upper limit for relative humidity in a facility to prevent fungal growth? a. 40 percent b. 5O percent c. 60 percent d. 70 percent

60 percent Rationale: Building materials contain fungal spores that have the potential to germinate in the correct conditions. Fungi require high relative humidity for growth, with most species needing relative humidity above 70 percent. Healthcare facilities should maintain relative.humidity below 60 percent to prevent the growth of fungus and to provide a comfortable patient care environment.

60. The following data on incidence rates of VAP in the Surgical ICU (SICU) were collected: • Incidence Rate of VAP NOTES 244' 244' 4.(.5s V-` Month 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 February

60c.o The incidence rate of VAP was highest in February Rationale: 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 February was higher than the rate for any other month. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance CBIC Core Competency: Surveillance and Epidemiologic Investigation Reference: APIC Text, 4th edition, Chapter 20

61. A major difference between a prospective and a 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

61. G May require a !Ong follow-up period Rationale: 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. Retrospective studies may be undertaken in a timelier and less-expensive manner than prospective cohort studies because cases may be identified retrospectively, and at least some exposure data are often available through medical record review. 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.

82. An infection prevention consultant is reviewing projected expenses for the next 2 years. Although all of the following are necessary to support the consultancy, which is considered a capital expense? a. An increase in office rent over 2 years b. Personal liability insurance c. Building utilities in which the office is located d. Expanded computer hardware and software

82. e Expanded computer hardware and software Rationale: Capital expenses or expenditures are business expenses for fixed assets such as buildings or equipment. Operating expenses such as rent, utilities, and insurance are not considered capital expenses. Reference: APIC Text, 4th edition, Chapter 1- Infection Prevention and Control Programs CBIC Core Competency: Management and Communication

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? a. (6 ÷ 240) x 1,000 = 25 per 1,000 patient 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 catheter days

84. Q (6 +180) x 1,000 = 33.3 per 1,000 catheter days, Rationale: A rate is calculated by dividing the numerator (number of occurrences) by the denominator (number of opportunities for that occurrenee) and then multiplying by a constant. Basic formula for all types of rates:,Rate = x/y x k Where: x = The numerator, which equals the number of times the event (e.g., infections) has occurred during a specified time interval. y = The denominator, which equals a population (e.g., number of patients at risk) from which those experiencing the event were derived during the same time interval. k = A constant used to transform the result of division into a uniform quantity so that it can be compared with other, similar quantities. A whole number (fractions are inconvenient) such as 100,1,000,10,000, or 100,000 is usually used (selection of k is usually made so that the smallest rate calculated has at least one digit to the left of the decimal point) or is determined by accepted practice (the magnitude of numerator compared with denominator). There are three important aspects of the formula: 1. Persons in the denominator must reflect the same population from which the numerator was taken. 2. Counts in the numerator and denominator should coyer the same • time period: 3. At least in theory, the persons in the denominator should have been at risk of the event or occurrence. Reference: APIC Text, 4th edition, Chapter 13

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 and a subset of the population in the denominator b. Proportions that include the population in the denominator and a subset of the population in the numerator c. Arithmetic mean d. Median

90. ()Median Rationale: The median is the point at which 50 percent of the values fall below a middle value and 50 percent of values occur above the middle value. It is the midpoint of the observations. The median ignores extreme values and is better at indicating values close to an average. Reference: APIC Text, 4th edition, Chapter 11

92. A staff nurse informs the IP that a patient with confirmed multidrug-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

92. e Airborne infection isolation room Rationale: Bronchoscopy permits direct visualization of airways Using a fiberoptic bronchoscope and is used in the diagnosis and management of inflammatory, infectious, and malignant diseases of the chest. Bronchoscopy should not be performed on patients with TB unless absolutely necessary. If medically necessary, bronchoscopy should only be performed in a room that meets the ventilation requirements for an airborne infection isolation room (negative directional air flow, a minimum of-12 air exchanges per hour and direct exhaust to the outside more than 25 feet from an air intake or discharged through a 'high efficiency particulate air filtration system). Reference: APIC Text, 4th edition, Chapter 55

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

93. G They have a thick peptidoglycan cell wall that retains the primary stain during the alcohol decolorization Rationale: Gram-positive cells will take up the initial crystal violet stain and will not be decolorized with alcohol because their peptidoglycan cell walls are thick enough to resist decolorization. - Reference: APIC Text, 4th edition, Chapter 24

94. Hepatitis A is diagnosed by the presence of: a. immunoglobulin G (IgG) for anti-Hepatitis D virus (HDV) b. Hepatitis A virus (HAV) lmmunoglobulin M (IgM) c. Increase in anti-Hepatitis B virus (HBV)-related to previous Hepatitis B infection d. HAV IgG

94. 0 Hepatitis A virus (HAV) immunoglobulin M (IgM) Rationale: The clinical case definition for acute viral hepatitis is (1) discrete onset ofsymptoms (e.g., nausea, anorexia, fever, malaise, or abdominal pain) and (2) jaundice or elevated serum aminotransferase levels. Because the clinical characteristics are the same for all types of acute viral hepatitis, Hepatitis A diagnosis must be confirmed by .a positive serologic test for IgM antibody to HAV, or the case must meet the clinical case definition and occur in a person who has an epidemiologic link with a person who has laboratory confirmed Hepatitis A (i.e., household or sexual contact with an infected person during the 15 to 50 days before the onset of symptoms). IgM is the first antibody built during immune response and is indicative of current disease. Reference: APIC Text, 4th edition, Chapter 97

95. When using a medication vial that is intended to be discarded after a single procedure, it is acceptable to reuse the same syringe that was just used to access that vial and give that patient medication if: a. The needle is replaced with a new needle b. The medication vial is a single-use vial c. The vial is only going to be used for that patient d. It is not acceptable to reuse the syringe

95. e It is not acceptable to reuse the syringe Rationale: While the medication in this example is expected to only be used on one patient, a healthcare worker should still use a new, sterile syringe and needle to access the medication vial the second time. This is a precaution in the event that the vial does not get discarded after use on this one patient and instead is accidentally used on another patient. References: APIC Text, 4th edition, Chapter 64

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

96. 0 Train the trainer Rationale: Train the trainer is an option for face-to-face institutional training when large numbers of staff must be quickly educated. Leader guides are used to train those responsible for implementing the program and for providing staff inservice and continuing education. These leader guides should be simply written, concise, and systematic. They should include curriculum goals and objectives, the course outline, instructional methods, references, and evaluation. Role playing is often used to allow the learner to experience a professional dilemma firsthand. Mentors may be used as a way to Upgrade and cross-train workforce. Case studies are viewed as an effective method to help bridge the learning gap between theory and actual practice. Reference: APIC Text, 4th edition, Chapter 3

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

97. 0 The decontamination process starts on the floor of the OR and works upward toward the lighting Rationale: At the end of each day's operating schedule, a complete terminal cleaning program should be initiated to ensure that every operating room, scrub room, and service room is properly and thoroughly cleaned. The decontamination process begins at the highest level (i.e., light tracks, ceiling fixtures) and progresses downward (i.e., shelves, tables, kick buckets, and floor). Reference: APIC Text, 4th edition, Chapter 68

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 the egg salad sandwiches? a. 15 percent b. 0.20 percent c. 18 percent d. 20 percent

99e. 20 percent The attack rate for this scenario is calculated as follows: 15 ÷ 75 x 100 = 20 percent. Rationale: An attack rate is a special form of incidence rate. In fact, it is not truly a rate but a proportion. It is the proportion of persons at 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 and is used almost exclusively for epidemics- or outbreaks of disease where a specific population is exposed to a disease for a limited period of time. Reference: APIC Text, 4th edition, Chapter 13

98. Which of the following patients would have the lowest risk of SSI? a. A 53-year-old male with insulin-dependent diabetes and coronary artery disease undergoing elective aortofemoral bypass b. A 38-year-old female with mild but controlled hypertension undergoing a laparoscopic cholecystectomy c. A 42-year-old, well-conditioned male undergoing elective groin hernia repair d. A 62-year-old female on chronic renal hemodialysis undergoing emergency laparotomy for perforated diverticulitis

A 42-year-old, well-conditioned male undergoing elective groin hernia repair Rationale: Elective procedures carry a lower risk for postoperative infection than urgent ones. It is important to consider these factors when making decisions regarding surgical outcomes and quality improvement assessments. A surgical risk index is a score used to predict a surgical patient's risk of acquiring a surgical site infection. The risk index score, ranging from 0 to 3, is the sum of the number of risk factors present among the following: '• Surgical site wound classification of contaminated or dirty (class III or IV) • American Society of Anesthesiology (ASA) score as rated by an anesthesiologist before operation of 3 • Prolonged procedure time, where the threshold in minutes (i.e., the cut point) is above the 75th percentile of the duration of surgery for the specific procedure being performed as determined by the NHSN database The higher the score by this index, the greater is the risk for subsequent SSI. Reference: APIC Text, 4th edition, Chapter 37 - Surgical

118. Which classroom setup best promotes interaction between learners and teachers? a. Stadium or auditorium style with clear sight lines and good acoustic b. Rectangular conference tables that promote a more formal space for learning c. Classroom style with straight rows of desks that also provide writing surfaces d. A horseshoe shape that also provides writing surfaces

A horseshoe shape that also provides writing surfaces Rationale: A horseshoe shape allows face to face participant contact while allowing the educator and equipment to be easily positioned for visibility. Whatever classroom setup is used, efforts should be made to encourage interaction via chair placement or grouping of participants. Reference: Chapter 3

101. Of the following sharp object injury examples, which would have the highest risk of transmission of bloodborne pathogens (assuming that all patient-related risk factors are identical for each example)? a. A nurse is stuck with an intravenous (IV) catheter stylet after withdrawing the stylet from the catheter b. A medical resident is stuck with a suture needle that had been used to suture a head wound c. A nurse is stuck with the needle from a syringe that had been used to give an intramuscular injection d. A surgeon sustains a superficial skin injury from a used disposable scalpel

A nurse is stuck with an intravenous (IV) catheter stylet after withdrawing the stylet from the catheter Rationale: IV catheter stylets are involved in only about 3 percent of sharp object injuries, but they have the highest risk of transmission of bloodborne pathogens because they are hollow-bore needles that can be. filled with blood. This results in greater exposure to bloodborne pathogens. References: APIC Text, 4th edition, Chapter 105 - CBIC

5. 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 of Candida albicans in a fungal blood culture in a patient with a urinary tract infection

A positive result of coagulase negative staphylococci from two sets, 2 days apart without symptoms Rationale: According to the CDC CLABSI criteria, common commensals (such as coagulase-negative staphylococci) 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). CDC CLABSI criteria: Patient has at least one of the following signs or symptoms: fever (greater than 38°C), chills, or hypotension and positive laboratory results are not related an infection at another site. And the same common commensal (i.e., diphtheroids [Corynebacterium spp.. not C. diphtheriae], Bacillus spp. [not B. anthracis], Propionibacterium spp., coagulase-negative Staphylococci.[inclyding S. epidermidis], viridans group streptococci, Aerococcus spp., and Micrococcus spp.) is cultured from two or more blood cultures drawn on separate Occasions. Criterion elements must occur within a time frame that does not exceed a gap of 1 calendar day between two adjacent elements.

HICPAC Categorization Scheme for Recommendations Category 1C

A strong recommendation required by state or federal regulation

106. The Infection Prevention Manager has been directed to design a new system for housewide surveillance of CLABSI in a 300-bed urban community teaching hospital. Which of the following tools would be most appropriate to help ensure that all aspects of this large-scale project are addressed? a. A detailed contingency plan b. A summary of the scope of work c. A quality management plan d. A work breakdown structure

A work breakdown structure Rationale: A work breakdown structure (WBS), is the decomposition of a project into smaller components. Elements of the plan may be a product, data, service, or any combination thereof. A WBS also provides the necessary framework for detailed cost estimating and control along with providing guidance for schedule development and control. Reference: Chapter 5

3. The IP has been notified that three patients with possible pneumonic plague have been admitted to the Emergency Department. The IP recommends which of the following strategies? a. A surgical mask worn within 3 feet of patient, door may be open, b. Negative pressure isolation room with use of N95 respirators c. Normal ventilation, but door must remain closed and N95 respirator mask worn d. No masks are required, but patient must be placed in private room and contacts should be treated for exposure

A. A surgical mask worn within 3 feet of patient, door may be open Rationale: Pneumonic plague is the least common form of naturally occurring. disease and also the most severe. Patient transport should be minimized to essential purposes only, and if movement is necessary, the patient should wear a surgical mask to minimize dispersal of droplets. Isolation generally can be discontinued after 48 hours of appropriate antimicrobial therapy. However, isolation should never be discontinued if the patient is not clinically improving.

30. A preliminary microbiology report states that a patient's bloodculture grew aerobic, Gram-negative bacilli. Which of the following is the most likely genus and species of the organism: a. Enterococcus faecalis b. Bacteroides fragilis c. Acinetobacter baumanii d. Neisseria meningitides

Acinetobacter baumanii Rationale: Acinetobacter baumannii is a aerobic, Gram-negative rod (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. Reference: APIC Text, 4th edition, Chapter 77

The RCA process takes a retrospective look at?

Adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring.

12. A nurse manager from a Rehabilitation Unit is requesting that aerators be installed on the sinks in the patient 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 HAls d. Low-flow aerators are suitable for use with this population

Aerators increase the risk of HAls Rationale: 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. Faucet aerators on sinks can enhance growth of waterborne organisms. Aerators are not recommended, but if they must be used, especially in an area with immunocompromised patients, a systematic cleaning routine should be established. Reference: APIC Text, 4th edition, Chapter 115

Describe Affinity diagrams:

Affinity diagrams gather large amounts of language data and creatively group the data based on lines of natural relationships. Data are usually collected from brainstorming or customer surveys. Interrelationship diagrams take complex, multivariable problems and graphically display all of the interrelated factors. They may also suggest cause-and-effect relationships, thereby providing focus for the team or project.

66. 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 Rationale: Airborne Precautions are used to prevent transmission of infectious organisms that remain suspended in the air and travel great distances. These diseases include measles, smallpox, chickenpox, pulmonary tuberculosis, avian influenza and possibly severe acute respiratory syndrome-associated coronavirus. Patients should be placed in an airborne infection isolation (All) room with negative air pressure relative to the corridor and at least 6 to 12 air exchanges with direct exhaust of air to the outside. Monitor the air pressure daily. Keep the door shut. Reference: APIC Text, 4th edition, Chapter. 29

71. There has been a major bioterrorism event in the area, as is evidenced by a large number of patients being admitted to local healthcare facilities with fever >101.1° F and respiratory symptoms that are progressing rapidly. Health officials are currently unaware of the causative organism. What type of Isolation Precautions are warranted in this situation? a. Standard Precautions b. Droplet Precautions c. Airborne Precautions d. Contact and Airborne Precautions

Airborne Precautions Rationale: During the beginning of an infectious disease disaster when the agent may not have been identified or when there is not enough evidence regarding the disease transmission route, IPs need to base infection prevention decisions on syndromes and symptomatology. This is referred to as syndrome-based isolation/control measures. General guidelines include implementing Airborne Precautions if the patient is severely ill with rapidly progressing respiratory symptoms and an airborne spread disease is suspected (i.e., severe acute respiratory syndrome or avian influenza). Reference: APIC Text, 4th edition, Chapter 120 - Infectious

4. Which one of the following best describes the difference between a common point source outbreak and a propagated outbreak? a. Case fatality rates in common source outbreaks are higher b. Person-to-person transmission is a feature of common source outbreaks c. The attack rate in prOpagated outbreaks is higher d. All cases in a common point source outbreak occur within one incubation period of the exposure

All cases in a common point source outbreak occur within one incubation period of the exposure Rationale: A common source epidemic is characterized by a rapid spread with cases presenting at the same stage of the disease, indicating the single source of the pathogen. Propagated outbreaks are outbreaks in which the disease propagates in one or more initial cases and then spreads to others, a relatively slow method of spread. Reference: APIC Text, 4th edition, Chapter 12 - Outbreak

24. A patient with a history of a cough greater than .3 weeks, night sweats, weight loss and a chest x-ray "suspicious for tuberculosis (TB)" is scheduled for a bronchoscopy. The procedure should be performed in which setting? a. The Operating Room under positive pressure b. Radiology c. An airborne infection isolation room with negative airflow d. Procedure room in Endoscopy

An airborne infection isolation room with negative airflow Rationale: When TB is suspected, a bronchoscopy should be performed only if medically necessary. The procedure should only be performed in a room that meets the ventilation requirements for an AIIR (negative directional airflow, a minimum of 12 air exchanges per hour, and direct exhaust to the outside more than 25 feet from an air intake or discharge through a high-efficiency particulate air [NEPA] filtration system). Reference: APIC Text, 4th edition, Chapter 95

64. Improved hydrogen peroxide contains: a. Anionic and/or nonionic surfactants b. Glutaraldehyde c. Peracetic acid d. Chlorine

Anionic and/or nonionic surfactants, Rationale: Improved hydrogen peroxide contains very low levels of anionic and/or nonionic surfactant in an acidic product that act with hydrogen peroxide to produce microbial activity. This combination of ingredients speeds the antimicrobial activity of hydrogen peroxide and clean efficiency. Reference: Chapter 31

92. A patient with a positive HBsAg must be dialyzed. Which of the following are the best measures to prevent transmission of disease? 1) Perform treatment in a separate room or area 2) Use a dedicated machine and equipment 3) Perform the treatment at the end of the day 4) Schedule the treatment on a separate day with other positive HBsAg patients a. 1,2 b. 2,4 c. 3,4 d. 1,3

Answer: 1 , 2 1) Perform treatment in a separate room or area 2) Use a dedicated machine and equipment Rationale: The CDC recommends separating HBsAg patients by room or area and using a separate, dedicated machine and equipment to reduce the risk of transmission of HBV in the dialysis setting. Patients who are known to be positive for HBsAg should be excluded from reprocessing programs because of the risk of transmission to susceptible reuse personnel. The incidence of HBsAg has been found to be higher in dialysis units that do not follow recommendations. Reference: APIC Text, 4th edition, Chapter 39 -

37. Bed bugs can survive without feeding for: a. 48 hours b. 24 days c. 6 month d. 1 year

Answer: 1 year Rationale: Immature bed bugs may live for several months without feeding, while adults may survive as long as one year without a meal. Under normal conditions, adult bed bugs will live for about ten to eleven months. Reference: APIC Text, 4th edition, Chapter 107 -

66. Which of the following are attributes of a culture of safety in a healthcare organization? 1) All HCP accept responsibility for safety 2) The organization prioritizes safety over financial and operational goals 3) Only personnel in leadership positions may report safety issues 4) The organization prioritizes identifying and reprimanding individuals who are responsible for accidents a. 1,2 b. 2,3 c: 3,4 d. 1, 4

Answer: 1, 2 1) All HCP accept responsibility for safety 2) The organization prioritizes safety over financial and operational goals Rationale: The NPSF outlines five attributes of a safety culture that all healthcare organizations should strive to operationalize through implementation of string safety management systems: • All workers (including front-line staff, physicians, and administrators) accept responsibility for the safety of themselves, their coworkers, patients, and visitors • Safety has priority over financial and operational goals • The organization encourages and rewards the identification, communication, and resolution of safety issues • There are provisions for organizational learning from accidents • The organization allocates appropriate resources, structure, and accountability to maintain effective safety systems Reference: APIC Text, 4th edition, Chapter 18 - Patient

32. Using Improved Hydrogen Peroxide offers many advantages. Those advantages are: 1) Rapid action 2) Low toxicity 3) Effective against spores 4) Low cost a. 1,2 b. 2,3 c. 2,4 d. 1, 4

Answer: 1, 2 1) Rapid action 2) Low toxicity Rationale: A major advantage of improved hydrogen peroxide is its rapid action, high effectiveness, and low toxicity. A disadvantage is it is more expensive than a quaternary ammonium compound in ready-to-use containers. Improved hydrogen peroxide is considered safe for humans and equipment, and benign for the environment. In fact, improved hydrogen peroxide has the lowest EPA toxicity category based on its oral, inhalation, and dermal toxicity, which means that it is practically nontoxic and is not an irritant. Reference: APIC Text, 4th edition, Chapter 31

111. The IP is teaching a group of ICU nurses about the risk factors for healthcare-associated infection (HAI) during patient care. Which of the following are factors that may influence the infectious risk? 1) Type of patient care activity 2) Mode of transmission of an infectious agent 3) Patient's host defenses 4) Patient's past surgical history a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

Answer: 1, 2, 3 1) Type of patient care activity 2) Mode of transmission of an infectious agent 3) Patient's host defenses Rationale: The risk of HAI during patient care is related to the mode of transmission of the infectious agent, the type of patient care activity or procedure being performed, and the individual's underlying host defenses. The duration of exposure, inoculum, and pathogenicity of the infectious agent also significantly influences the infection risk. Reference: Chapter 21

89. lmmunoglobulins are available for which of the following? 1) Tetanus 2) Rubella 3) Pertussis 4) Varicella-zoster a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

Answer: 1, 2, 4 1) Tetanus 2) Rubella 4) Varicella-zoster Rationale: lmmunoglobulins are special concentrated antibody preparations that provide immediate short-term protection against disease for individuals who are at high risk of experiencing severe disease or of developing serious complications from the disease. Human normal immunoglobulin preparations for Hepatitis A, measles, polio, and rubella, and specific immunoglobulin preparations for Hepatitis B, rabies, and varicella-zoster for intramuscular use, are available.

73. You have been invited to tour a commercial third-party reprocessor that your organization is considering using to reprocess some equipment. As the IP, you should request to observe which of the following? 1) Observe the cleaning and decontamination process 2) Observe hand hygiene 3) Sterilizing load preparation process 4) New employee orientation a. 1,2 b. 2,4 c. 2,3 d. 1,3

Answer: 1, 3 1) Observe the cleaning and decontamination process 3) Sterilizing load preparation process Rationale: Healthcare facilities considering contracting with a commercial third-party reprocessor have the responsibility of knowing that reprocessing an SUD presents no greater risk to their patients' health and safety. An onsite visit 'should be scheduled, with the opportunity to meet with personnel involved in the process, and a review of the company's policies. The visit should include an opportunity to observe the cleaning and decontamination, inspection and testing, and sterilization load preparation processes, as well as reviewing quality control records. Reference: APIC Text, 4th edition, Chapter 32 -

87. An IP recommends that chlorhexidine gluconate (CHG) be used to prepare a site for the insertion of a peripherally inserted central catheter (PICC) because it: 1) Requires only 30 seconds to dry 2) Can be used for all ages 3) Is not associated with allergic reactions 4) Can be easily rinsed after the line is inserted a. 3,4 b. 1,3 c. 2,3 d. 1,4.

Answer: 1, 3 1) Requires only 30 seconds to dry 3) Is not associated with allergic reactions Rationale: CHG products are increasingly used because of their effectiveness, 30-secOnd dry time, and low incidence of allergic reactions. CHG products do not need to be removed or rinsed from the skin following venipuncture. CHG is not approved for use with infants younger than 2 months of age. References: APIC Text, 4th edition, Chapter 24

46. A physician would like to use a new screening test for methicillin resistant Staphylococcus aureus (MRSA), which is highly prevalent in the hospital population. The screening test has a sensitivity of 98 percent and a specificity of 58 percent. Which of the following conclusions is most accurate about this screening test? 1) The test will be very effective in correctly identifying people who have MRSA 2) The test will be very effective in correctly identifying people who do not have MRSA 3) The test will yield very few false-negative results 4) The test will yield very few false-positive results a. 1,3 b. 1, 4 c. 2,3 d. 2,4

Answer: 1, 3 1) The test will be very effective in correctly identifying people who have MRSA 3) The test will yield very few false-negative results Rationale: A high sensitivity means that most people who actually have the disease will have a positive test result; this also means that few people who have the disease will have a negative test result, so the number of false negatives will be low. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance CBIC Core Competency: Surveillance and Epidelmiologic Investigation

43. IPs should have a thorough understanding of the following when choosing a cleaning product: 1) Differences among types and uses of disinfectants 2) Manufacturing companies that produce and sell disinfectants 3) Definitions of the terms cleaning, sanitization, disinfection and sanitizer 4) Manufacturer's recommendations for use, including dilution and contact time a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

Answer: 1, 3, 4 1) Differences among types and uses of disinfectants 3) Definitions of the terms cleaning, sanitization, disinfection and sanitizer 4) Manufacturer's recommendations for use, including dilution and contact time Rationale: Environmental services managers, IPs, and other individuals responsible for selecting, purchasing, and/or educating others on the use of cleaning products should have a thorough understanding of the differences and uses of these chemicals. Specifically, these individuals should know: • Definitions of the terms cleaning, sanitization, disinfection, and sterilization • Definitions of soap, antiseptic, disinfectant, sterilant, and sanitizer • Differences among the types and uses of antiseptics • Differences among the types and uses of disinfectants, including sporicidal disinfectants • Differences among a disinfectant, a disinfectant-detergent, and a cleaning agent containing no antimicrobial properties • Manufacturer's specification for use, including dilution and contact time • Difference between products registered with the EPA and the FDA Reference: APIC Text, 4th edition, Chapter 107 -

77. Which of the following is an example of a continuous data set? 1) Body temperature measurements: 98.6°F, 97.4°F, 99.8°F, 99.9°F 2) Gender: male, male, female, male 3) Blood type: 0+, A-, A+, AB+ 4) Body weight: 189, 144, 261, 113 a. 1,2 b. 2,3 c. 2,4 d. 1,4

Answer: 1, 4 1) Body temperature measurements: 98.6°F, 97.4°F, 99.8°F, 99.9°F 4) Body weight: 189, 144, 261, 113 Rationale: Continuous data contain information that can be measured on a continuum or scale and can have numeric values between the minimum and maximum value (a continuum) (e.g., age; serum cholesterol level; temperature, such as 98.6°F, 98.7°F, and 98.8°F; infection rates); continuous data require the process of measuring, rather than counting, and may contain whole numbers, decimals, or percentages. Conversely, discrete data contain whole numbers and are mutually exclusive (e.g.; infected or not infected, male or female, blood type). Reference: APIC Text, 4th edition, Chapter 13

109. The IP is notified of a positive Legionella test in an individual who has resided in the healthcare facility for 2 months. Which of the following are potential sources of Legionella that should be investigated? 1) Cooling towers 2) IV solutions 3) Air conditioners 4) Ice machines a. 1,4 b. 1,3 c. 3,4 d. 2,4

Answer: 1, 4 1) Cooling towers 4) Ice machines Rationale: L. pneumophila is a common cause of both community-acquired and healthcare-associated pneumonia. Clinical manifestations are nonspecific, but high fever, diarrhea, and hypernatremia are common. Infection has been linked to drinking water distribution systems of acute care and extended care facilities. When a patient receives a diagnosis of healthcare-associated Legionnaires' disease, culturing of the water sites to which the patient was exposed is indicated. Distal sites include water faucets, ice machines, water used in respiratory tract devices, and water sources to which the patient is exposed. Air conditioners have not been implicated in Legionnaires' disease. IV solutions are not known to be sources of Leg/one//a infections.

58. Privacy curtains are high-touch items that should be changed and cleaned: 1) On a routine schedule and when soiled 2) During construction 3) According to manufacturer's instructions 4) After a patient on Contact Isolation is discharged or transferred a. 1,2 b. 2,3 c. 3,4 d. 1, 4

Answer: 1, 4 1) On a routine schedule and when soiled 4) After a patient on Contact Isolation is discharged or transferred Rationale: Privacy curtains are considered high-touch items and are to be changed and cleaned on a routine schedule and whenever soiled. It is also recommended that they be changed after a patient on Contact Isolation is either transferred or discharged.

90. The Director of Infection Prevention and Control has been asked to lead a team in the development of an antimicrobial stewardship program at an organization. Core members should include: 1) Pharmacist 2) Risk manager 3) Respiratory therapist 4) Infectious disease physician a. 1,2 b. 1,4 c. 3,4 d. 2,3

Answer: 1, 4 1) Pharmacist 4) Infectious disease physician Rationale: Multidisciplinary groups, including pharmacists, should establish a system for monitoring resistance and antibiotic usage, establish practice guidelines and other polices to control the use of antibiotics, respond to data from the monitoring system, and measure outcomes to evaluate the effectiveness of policies. Ideally, core members of an antimicrobial stewardship team include an infectious diseases physician, a clinical pharmacist with infectious diseases training, a clinical microbiologist, an information system specialist, an P. and a hospital epidemiologist. Reference: APIC Text, 4th edition, Chapter 110

134. Maximal barrier precautions for central line insertion include: 1) Sterile surgical gown and gloves 2) Closing the door to the room 3) Non-sterile gown and gloves 4) Mask, cap, sterile drape (head to toe) a. 1,4 b. 2,3 c. 1,3 d. 2,4

Answer: 1, 4 ) Sterile surgical gown and gloves 4) Mask, cap, sterile drape (head to toe) Rationale: Use maximal sterile barrier, precautions, including the use Of a cap, mask, sterile gown, sterile gloves, and a sterile full body drape for the insertion of central venous catheters, peripherally inserted central venous catheters, or guidewire exchanges. Reference: Chapter 34

47. The risk of infection or adverse reactions in the Dialysis Unit can be reduced by which of the following interventions? 1) Test patients and staff for MRSA colonization and treat as needed 2) Adhere to aseptic technique during all dialysis procedures 3) Have patient cleanse the access site With soap and water daily and prior to dialysis 4) Have patients take a prophylactic antibiotic prior to dialysis a. 1,3 b. 2,3 c. 1,2 d. 1,3

Answer: 2, 3 2) Adhere to aseptic technique during all dialysis procedures 3) Have patient cleanse the access site With soap and water daily and prior to dialysis Rationale: Most common types of dialysis-associated infections include access site infection, bacteremia, and peritonitis. The risk of infection or adverse reactions in the dialysis unit can be reduced by strict adherence to aseptic technique during all dialysis procedures. Skin colonization with S. aureus at the access site has been significantly associated with S. aureus access site infections. Persistence of S. aureus after skin preparation has been shown to be significantly higher in patients with poor hygiene. Therefore, the importance of personal hygiene and its possible relation to access site infections should be emphasized. It is recommended that all patients be taught to wash their access site with soap and water daily and before hemodialysis. Reference: APIC Text, 4th edition, Chapter 39 - Dialysis

103. There is a suspected case of measles in the ED of a facility, and the patient has been admitted. A nasopharyngeal swab was taken, placed in viral transport media, and sent to the lab where it was frozen at -20°C for 12 hours and then thawed and placed in culture. The culture results are negative for measles virus. Which of the following should the IP request for this patient? 1) A new sample should be collected and placed in a -20°C environment immediately 2) A new sample should be collected and placed in culture immediately 3) The patient should be placed in an airborne infection isolation room .4) The patient should be placed in a standard room without isolation precautions a. 1 b. 4 c. 2,3 d. 1, 2, 3

Answer: 2,3 2) A new sample should be collected and placed in culture immediately 3) The patient should be placed in an airborne infection isolation room Rationale: Measles, or Rubeola, virus is a temperature labile virus that should be transported on ice to the lab as soon as possible after collection and placed in culture immediately or frozen at -70°C until being placed in culture. Measles virus samples should not be kept at room temperature or frozen at 720°C because these temperatures will lower the infectivity of the virus in the sample and this could produce a false negative result. The patient must be placed in an airborne infection isolation room because there is a clinical suspicion of measles and the initial negative test was not performed properly. References: APIC Text, 4th edition, Chapter 86 - Measles,

15. You are participating in a team to select and evaluate novel environmental disinfectant products. When preparing a presentation to the team on the advantages of ultra violet (UV) irradiation, it is important to include information on: 1) Patients may remain in the room with the device operating 2) Decontamination can be achieved in 2.5 hours 3) HVAC system does not need to be disabled 4) Ability to achieve reductions in vegetative bacteria a. 1,4 b. 2, 4 c. 3,4 d. 1,3

Answer: 3, 4 3) HVAC system does not need to be disabled 4) Ability to achieve reductions in vegetative bacteria Rationale: UV irradiation has been used for the control of pathogenic microorganisms in a variety of applications, such as control of Legionellosis, as well as disinfection of air, surfaces, and instruments. UV irradiation is effective substantially reducing levels of vegetative bacteria. All patients and staff must be removed from the room prior to decontamination. Rooms can be rapidly decontaminated of vegetative bacteria in 15 to 20 minutes. All patients and staff must be removed from the room prior to decontamination Reference: APIC Text, 4th edition, Chapter 31

48. An IP is interested in evaluating whether her educational program on utilizing PPE has led to applied changes in practice. What is the 'best method of determining this? a. Use a pretest and posttest evaluation to see how knowledge of PPE use has changed after the educational program b. Use formative evaluation of the program so she can make necessary changes before it is implemented c. Use exit questionnaires to find out whether participants intend to implement their new knowledge in a practice situation d. Ask the supervisor to collect data on direct observation of practice

Answer: Ask the supervisor to collect data on direct observation of practice Rationale: Educators may use evaluation at different points within the program development process. Formative evaluation is conducted during the planning of the educational session to provide immediate feedback and to allow appropriate changes to be made. Data collected by pretest and posttest before and after an intervention are used to measure change in individual or group understanding of the content but will not provide information on application of knowledge in a practice setting. Exit questionnaires are used to gather information about the overall success of the program to ask for feedback on all aspects of the course, including objectives, the presenter, the quality of teaching aids, and the learning environment. Direct observation of practice would provide the best method to assess whether employees are applying the learning objectives on the job. Reference: APIC Text, 4th edition, Chapter 3 - Education

102. Which letter labels the areas under the curve that represents special cause variance in healthcare-associated CLABSI? Mean Number of standard deviations beyond the mean a. K b. L c. M d. N

Answer: N Rationale: Special cause variation is variation that lies more than 3 standard deviations outside the mean of the sample distribution. Common cause variation represents variation within 3 standard deviations of the mean and includes 99.73 percent of all probably events, so special cause variation represents the remaining 0.27 percent of all events. Chapter 14

70. The incidence of VRE in the Burn Unit last quarter was 3.0, and the incidence of VRE in the Bone Marrow Transplant Unit last quarter was 1.0. What was the relative risk (RR) of new cases of VRE in the Burn Unit compared to the Bone Marrow Transplant Unit? a. RR = 3.0 b. RR = 0.33 c. RR = 4.0 d. RR = 2.0

Answer: RR = 3.0 Rationale: RR is the incidence in the exposed group divided by the incidence in the unexposed group. This case is simply comparing the incidence in two units. Because the question asks for the relative risk in the Burn Unit as compared to the Bone Marrow Transplant Unit, the Burn Unit should be considered to be the exposed group. The RR is the incidence in the Burn Unit divided by the incidence in the Bone Marrow Transplant Unit, which is 3.0/1.0. This is equal to 3.0. Thus patients in the burn unit had 3 times higher risk of newly acquired VRE than patients in the bone marrow transplant unit. Reference: APIC Text, 4th edition, Chapter 13

44. The Surgical Scheduling Department called the IP stating that a patient scheduled for surgery in on December 24 will need to reschedule his procedure due to an exposure to scarlet fever on December 3. He has no signs or symptoms. How should the IP respond? a. The incubation period for scarlet fever is Usually 1 to 7 days; he is outside the incubation period and will be able to have his surgery on the scheduled date b. The procedure should be rescheduled c. Request an order from the surgeon for antibiotics to treat the possible exposure d. Place the patient in Isolation Precautions upon admission

Answer: The incubation period for scarlet fever is usually 1 to 7 days; he is outside the incubation period and will be able to have his surgery on the scheduled date Rationale: Group A Streptococcus (GAS) is one of the most frequent and important pathogens in humans. Spread of GAS occurs by direct personto- person contact. Symptoms of scarlet fever typically appear 3 days after exposure to another person with the illness, though this incubation period can be anywhere from 1 to 7 days. When scarlet fever occurs, it is usually the result of pharyngeal infection, but it can occur in the setting of GAS skin infection or sepsis. It is characterized by a diffuse red rash that typically appears on the second day of illness, lends a sandpaper texture to the skin, and fades over the course of a week. It is followed by desquamation of the skin. The patient is outside the incubation period and will be able to have his surgery on the scheduled date. He should also be instructed to call back if he develops a fever or other signs/symptoms of an illness prior to the surgery date. Reference: Streptococcal Diseases. In: Heymann D.

Bioterrorism: Category A diseases/agents include

Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo])

112. Which of the following laboratory methods is utilized for viral testing? a. Gram staining, to quickly confirm presence of infection b. Broth dilution, to determine antimicrobial resistance via minimal inhibitory concentration (MIC) c. Antibody assay, to detect viral antibodies in the serum d. Antibody assay, to detect viral antibodies in clinical specimen

Antibody assay to detect viral antibodies in the serum Rationale: There are three major methods to diagnose viral infections: direct detection in the clinical specimen, specific antibody assay to detect viral antibodies in the serum, and viral culture. Gram staining and broth dilution are used for bacterial pathogens. Antibody assays are performed on serum. Reference: Chapter 24

Bioterrorism agents category A

Bacillus anthracis (anthrax) Clostridium botulinum toxin (botulism) Yersinia pestis (plague) Variola major (smallpox) and other related pox viruses Francisella tularensis (tularemia) Viral hemorrhagic fevers: Ebola, Marbug

4. What type of meningitis would be most consistent with the following cerebrospinal fluid (CSF) report result: +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Glucose: decreased Protein: elevated WBC: 1,000/mm(3) +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ a. Bacterial b. Viral c. Fungal d. Tuberculosis

Bacterial Rationale: 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 pleocytosis (>WBC in CSF) with a predominance of neutrophils, low glucose, 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 samples was obtained before the administration of antibiotics. Reference: APIC Text, 4th edition, Chapter 74 - Central Nervous System Infection

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 Rationale: Blood and blood products, as defined in the OSHA Bloodb.orne Pathogen Standard (e.g., serum, plasma, and other components known or suspected to be contaminated with a transmissible agent) must be handled carefully. Small amounts of these materials dried on dressings or other disposable items represent an insignificant hazard once they are properly contained because of the absence of a portal of entry and a means of transmission. Bulk blood, blood-tinged suctioned fluids, excretions, and secretions are considered infectious waste because they may be splashed onto mucous membranes or the container may break and become a contaminated sharp. These fluids may be carefully poured down a drain connected to a sanitary sewer that is designed for the disposal of human waste. Personnel must follow Standard Precautions due to splash and aerosolization potential. Alternative treatment methods for inactivation or handling prior to disposal are available. Reference: Chapter 113

75. There is a bioterrorism event in a city. Patients are presenting to the Emergency Room with blurred vision, descending symmetrical flaccid paralysis, and respiratory failure. The most likely bioterrorism disease is: a. Botulism b. Pneumonic plague c. Viral hemorrhagic fever d. Smallpox

Botulism Rationale: Botulism is a public health emergency. Botulism is a neuroparalytic illness caused by a toxin made by the bacterium C. botulinum. Symptoms of botulism include blurred vision, diplopia, dysarthria, dysphagia, symmetrical descending flaccid paralysis and respiratory failure. Prompt diagnosis and early treatment of botulism are essential to minimize the number of affected persons and the severity of illness. Reference: APIC Text, 4th edition, Chapter 120 - Infectious

Bioterrorism: Category B diseases/agents include:

Brucellosis (Bruce//a species) Epsilon toxin of Clostridium perfringens Food safety threats (e.g., Salmonella. species, E. coli 0157:H7, Shigella) Glanders (Burkholderia Melioidosis (Burkholderia pseudomallei) Psittacosis (Chlamydia psittaci) Q fever (Coxiella burned') Ricin toxin from Ricinus communis (castor beans)Staphylococcal enterotoxin B Typhus fever (Rickettsia prowazekii) Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]) Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

Bioterrorism agents category B

Burkholderia pseudomallei (melioidosis) Coxiella burnetii (Q fever) Brucella species (brucellosis) Burkholderia mallei (glanders) Chlamydia psittaci (Psittacosis) Ricin toxin (Ricinus communis) Epsilon toxin (Clostridium perfringens) Staphylococcus enterotoxin B (SEB) Typhus fever (Rickettsia prowazekii) Food- and waterborne pathogens

4. Using the surgical risk index to stratify the identified infections for the previous quarter, an IP would report which of the following case(s) as having a higher risk for developing a surgical site infection (SSI)? 1) An 80-year-old male with poor circulation who develops a donor site infection after a coronary artery bypass graft surgery that took 4 hours to perform 2) A 30-year-old female who has knee surgery to repair a torn anterior cruciate ligament (ACL) after a skiing accident 3) A 90-year-old female with insulin-dependent diabetes who has hip replacement surgery that takes 2.5 hours to perform 4) A 27-year-old male with Crohn's disease who has colon resection that takes more than 4 hours to perform due to adhesions a. 1, 2 b. 2,3 C. 3, 4 d. 1, 4

C. 3,4 3) A 90-year-old female with insulin-dependent diabetes who has hip replacement surgery that takes 2.5 hours to perform 4) A 27-year-old male with Crohn's disease who has colon resection that takes more than 4 hours to perform due to adhesions Rationale: A surgical risk index is a score used to predict a surgical patient's risk of acquiring an SSI. The risk index score, ranging from 0 to 3, is the sum of the number of risk factors present among the following; 1. A patient with an ASA physical status classification score of 3, 4, or 5 2. An operation classified as contaminated or dirty/infected 3. An operation lasting longer than the duration cut point in minutes, where the duration cut point varies by the type of operative procedure performed The higher the score by this index, the greater is the risk for subsequent SS. Patient 1 the 80 year old male with a donor site infection has a risk index of 1 and an ASA score of 3. Patient 2 the 30 year old has a risk index of 0. Patient 3 the 90 year old diabetic has an ASA score of 3 and an operation lasting longer than the duration cut point in minutes; her risk index would be 2. Patient 4 the colon resection has a Class II procedure (contaminated) and an operation lasting longer than the duration cut point in minutes; his risk index is 2.

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 Rationale: 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 exposures that are associated with the bloodstream infections. References: APIC Text, 4th edition, Chapter 10 - General

93. Which of the following tasks would require wearing sterile gloves? a. Central line dressing change b. Routine dressing change without debridement c. Wound cleaning d. Intramuscular (IM) injection

Central line dressing change Rationale: Sterile supplies and sterile technique should be used for central line dressing changes.

Describe the clinical infection of mumps

Clinical infection is characterized by swollen salivary glands (parotitis), high fever, and fatigue. Transmission occurs through droplets of respiratory secretions. Communicability is comparable to influenza and rubella, less than that of varicella or measles, and is maximal from 2 days before onset of parotitis to 9 days after. The average incubation period for mumps is 18 days, with a range of 12 to 25 days.

Keratitis is the inflammation of the?

Cornea—the clear dome at the front of the eye. Microbial keratitis is a true ocular emergency. Few organisms can invade the intact cornea. If the cornea epithelium is breached by trauma, insertion/removal of contact lens, or surgical intervention, organisms can enter, multiply, and destroy ocular tissue and structures. Multistate outbreaks of Fusariumand Acanthamoeba associated with contaminated contact lens solutions highlight the need for infection prevention and patient safety education in ophthalmic centers. The Fusarium outbreak was worldwide and linked to contact lens cleaning and disinfecting solution

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 as 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 Rationale: The goal of simulation is to create a controlled learning environment that closely resembles the practice setting. This process facilitates use of practical and critical thinking skills on the part of the participant and serves to protect the safety of the patient. One example of a simulation room may be to create a mock isolation room. The goal may be to increase the awareness of the nursing staff regarding common infection prevention infractions that may occur during the provision of care. The simulation would enable participants to practice infection prevention activities necessary to care for patients. Reference: Chapter 3

54. A 70-year-old patient is admitted with symptoms of rapid neurological degeneration. The physician orders the following diagnostic tests: 14 - 3 - 3 spinal fluid assay, an electroencephalogram (EEG), and magnetic resonance imaging (MRI). These tests, if positive, may indicate a possible diagnosis of: a. A brain tumor b. Viral encephalopathy c. Multiple sclerosis d. Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease Rationale: Classic Creutzfeldt-Jakob disease (CJD) is a human prion disease. It is a neurodegenerative disorder with ,characteristic clinical and diagnostic features. This disease is rapidly progressive and always fatal. Infection with this disease leads to death usually within 1 year of onset of illness. A probable diagnosis of CJD is made using the following algorithm: Probable: i. Rapidly progressive dementia; and at least two out of the following four clinical features: Myoclonus iii. Visual or cerebellar signs iv. Pyramidal/extrapyramidal signs v. Akinetic mutism AND a positive result on at least one of the following laboratory tests: i. A typical EEG. (periodic sharp wave complexes) during an illness of any duration; and/or ii. A positive 14-3-3 CSF assay in patients with a disease duration of less than 2 years iii. Magnetic resonance imaging high-signal abnormalities in caudate nucleus and/or putamen on diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR) AND without routine investigations indicating an alternative diagnosis. Confirmation of the diagnosis is by brain biopsy or pathological analysis of the mortem brain. Reference: APIC Text, 4th edition, Chapter 73

78. Which of the following refers to the ability to evaluate, compare, analyze, critique, and synthesize information? a. Inductive thinking b. Critical thinking c. Transductive thinking d. Deductive thinking

Critical thinking Rationale: Critical thinking is the identification and evaluation of evidence to guide decision-making. The list of core critical thinking skills includes observation, interpretation, analysis, inference, evaluation, explanation, and metacognition. Critical thinking is imperative when evaluating and interpreting research studies. Reference: APIC Text, 4th edition, Chapter 2

129. Which of the following would be best studied via qualitative research? a. The effect of preoperative bathing with CHG on SSI rates b. Declining influenza vaccination rates in HCP c. MRSA colonization rates in dialysis patients d. Reoccurrence of C. difficile in nursing home patients

Declining influenza vaccination rates in HCP Rationale: Qualitative research methods can be used to study phenomena of interest to IPs, including HCP adherence to infection prevention recommendations (e.g., immunization schedules, hand hygiene, and safe surgical techniques). By using qualitative methods, IPs can systematically identify variables and relationships among variables that influence the practices and behavior of HCP. Qualitative research can be used to determine why HCP are not receiving the flu vaccine. 'Reference: APIC Text, 4th edition, Chapter 19

87. Which of the following air filtration methods has the highest filtering efficiency compared to the others? a. Diffusion b. Straining c. Impingement d. Interception

Diffusion Rationale: When air enters a facility's ventilation system from the outside it passes through a series of filters that remove particulate matter. The first bank of filters has low to medium efficiency for removing particles and can include straining, impingement, and interception filtration methods. This air is then mixed with the recirculated air from the facility and filtered again with high efficiency filtration methods including diffusion filtration.

96. Based on current CDC guidelines, which of the following modes of transmission is most responsible for contamination of a central venous catheter? a. Airborne b. Direct contact c. Indirect contact d. Droplet spread

Direct contact Rationale: According to the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, there are four recognized routes for contamination of catheters: (1) migration of skin organisms at the insertion site into the cutaneous catheter tract and along the surface of the catheter with colonization of the catheter tip; this is the most common route of infection for short-term catheters; (2) direct contamination of the catheter or catheter hub by contact with hands or contaminated fluids or devices; (3) less commonly, catheters might become hematogenously seeded from another focus of infection; and (4) rarely, infusate contamination might lead to catheter-related bloodstream infections.

39: As a time-saving measure, hospital administrators in your facility have suggested that endocavitary probes do not need to undergo high-level disinfection because they are used with probe covers. How would you respond to this suggestion? a. Agree, because the probe cover prevents contact with mucous membranes and non-intact skin b. Disagree, because the probe covers are not 100 percent reliable c. Agree, because even without covers the probes don't contact mucous membranes and non-intact skin during use d. Disagree, because switching from high-level disinfection to low-level disinfection will not save time

Disagree, because the probe covers are not 100 percent reliable Rationale: Any patient care items that come into contact with mucous membranes and non-intact skin must undergo high-level disinfection. While probe covers are used for endocavitary probes like vaginal probes, the probe covers are prone to perforation before and during use, which can lead to contamination of the probe during the procedure.

16. Which part of a published research study contains a brief summary of the entire research process with interpretation of data, conclusions from the data, limitations of the study and recommendations for further research? a. Introduction b. Methods c. Results d. Discussion

Discussion Rationale: The discussion section of a research study reviews, interprets, and evaluates the results of the study. This section usually lists the hypothesis or hypotheses and reports whether the results supported or contradicted the hypothesis. Similarities and differences between the Current findings and findings of previous research are reviewed. Limitations of the current study are discussed and suggestions are made on improving the research design. The discussion section usually ends with recommendations for future research. References: APIC Text, 4th edition, Chapter 20

Droplet Precautions are recommended for people with acute mumps infection for ?

Droplet Precautions are recommended for people with acute mumps infection for 9 days after onset of parotid swelling. Susceptible healthcare personnel should not care for such patients; use immune personnel instead

84. The IP is consulted prior to the construction of a new unit in her hospital. The design that is most concerning to her is: a. All rooms (AIIR) that have negative air pressure b. Protective environment rooms that have positive air pressure c. Dual-purpose rooms that can alternate between negative and positive air pressure d. All rooms with neutral air pressure

Dual-purpose rooms that can alternate between negative and positive air pressure Rationale: Isolation rooms can serve two purposes. The first is to provide appropriate isolation for patients infected with pathogens that are transmitted by the airborne route (e.g., M. tuberculosis, varicella-zoster virus, rubeola [measles] virus). The major goal in this situation is to prevent transmission of pathogens from an infected patient to other patients, staff, or visitors. This is generally achieved by maintaining AIIRs. The second purpose is to provide a PE for severely immunosuppressed patients. AIIRs have negative air pressure, and PE rooms have positive air pressure with respect to adjacent areas. Correct direction of airflow and properly balanced air pressure, in AIIR or PE areas are essential elements to consider during construction and renovation. The Facility Guidelines Institute's (FGI) Guidelines do not support "reversible" airflow rooms based on complexity of pressure relationships, concerns for serious patient and HCP outcomes if errors are made, and labor intensity needed for preventive maintenance. , Reference: APIC Text, 4th edition, Chapter 116

2. A early sign of Lyme disease is: a. Kaposi sarcoma b. Stiff neck c. Koplik spots d. Bull's-eye rash

Early Signs and Symptoms which is 3 to 30 days after tick bite includes: 1. Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes 2. Erythema migrans (EM) rash: Occurs in approximately 70 to 80 percent of infected persons 3. Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days) 4. Expands gradually over a period of days reaching up to 12 inches or more (30 cm) across 5. May feel warm to the touch but is rarely itchy or painful 6. Sometimes clears as it enlarges, resulting in a target or "bull's-eye" appearance 7. May appear on any area of the body

85. Which of the following clinical uses would not be indicated for Gram stain results? a. Early identification of antibiotic resistance b. Initial direction for empiric antibiotic treatment c. Quality of the specimen d. Need for Isolation Precautions,

Early identification of antibiotic resistance Rationale: Gram staining of a specimen may help to determine the quality of a specimen, initial direction for therapy (empiric antibiotics), or the need for Isolation Precautions (e.g., Gram-negative diplococci in CSF, suggesting meningococci). It does not identify antibiotic resistance. Reference: APIC Text, 4th edition, Chapter 24

123. A patient in the Neurosurgical ICU develops a fever. Cultures are ordered and collected. The physician decides to start an antibiotic while waiting for the culture results because the patient is critically ill. This type of antibiotic usage is called: a. Empiric b. Prophylactic c. Therapeutic d. Pathogen-directed

Empiric Rationale: When no definitive information about a causative pathogen is available (though Gram stain can be highly suggestive), therapy is said to be empirical. Typically, hospitalized patients are sufficiently ill to warrant treatment before culture and sensitivity results are available, and therapy while the results of cultures are pending may represent most empirical therapy. Especially in hospitalized patients, appropriate cultures, usually including more than one blood culture, should be collected before the initiation of therapy. The site of infection determined clinically (e.g., lung, urinary tract) and host factors (e.g., HIV, organ transplant patient) give an indication of likely pathogens and should shape the decision regarding empirical therapy. Empirical therapy, compared with pathogen-directed therapy, is broader in spectrum due to uncertainty about the causative agent. Reference: AP1C Text, 4th edition, Chapter 26

71. While reviewing blood culture reports, you notice a note indicating that the specimen was received in the lab 3 hours after it was collected. You confirm with the microbiology supervisor. The acceptable transport time is: a. Place specimen on ice and transport within one hour of collection b. Within 24 hours of collection at room temperature c. Equal to or less than 2 hours at room temperature d. Equal to or greater than 4 hours if refrigerated

Equal to or less than 2 hours at room temperature Rationale: The reliability and value of test results depends on numerous factors. Improper collection, transport, or processing of a specimen can decrease the quality of patient care or result in unnecessary additional testing or treatment. Blood Culture bottles must be transported to the Lab within a time frame equal to or less than two hours and must be maintained at room temperature.

99. What organism is most often associated with urinary tract infections? a. Enterococcus sp. b. Candida sp. c. Klebsiella pneumoniae or K. oxytoca d. Escherichia coli

Escherichia coil Rationale: In the United States, urinary tract infections account for about 4 million ambulatory care visits each year, representing about 1 percent of all outpatient Visits. Gram-negative bacilli and enterococci are the primary enteric bacteria that can grow in human urine. The presence of bacteria in urine almost always precedes intestinal colonization by the infecting bacteria. E. coli is the predominant aerobic Gram-negative organism of normal bowel flora, and thus is the most common organism isolated from urinary tract infections. Reference: APIC Text, 4th edition, Chapter 33 - Urinary

130. Which of the following statements is true regarding the evaluation of an educational program? a. The evaluation should only be done at the end of the program b. Evaluation measurements must be consistent with the objectives of the program c. The evaluation always includes one-on-one interviews to assess the ability of the individual learner to perform d. The evaluation should not be used to monitor the behavior change—this is the role of the presenter

Evaluation measurements must be consistent with the objectives of the program Rationale: The educator may use evaluation at different points within the program development process using a variety of methods. Whatever evaluation methodology is used, evaluation measurements must be consistent with the objectives established for the educational program„ Data must be gathered, tabulated, and analyzed to assess impact and make recommendations for curriculum revision before the next presentation. Reference: APIC Text, 4th edition, Chapter 3 -

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 Rationale: Epidemiology provides the background for interventions to reduce the transmission of infecting organisms. Selecting appropriate study design is an essential step in answering questions important to the IP. Experimental designs are always prospective. The investigator manipulates one or more factors (variables) while the others remain constant. In true experiments, randomization is used. Experimental studies can establish association and may establish causality, (when) other factors are strictly controlled. References: APIC Text, 4th edition, Chapter 10

63. An orthopedic surgeon is requesting that all "dirty" cases be scheduled for the end of the day. The IP's response is to: a. Ask the Director of Surgical Services to comply with his request b. Explain to the surgeon that operating rooms are cleaned after each case and that there is no benefit to scheduling procedures at the end of the day c. Provide the surgeon with the cleaning policy and ignore his request d. Request a meeting with the Environmental Services director to discuss

Explain to the surgeon that operating rooms are cleaned after each case and that there is no benefit to scheduling procedures at the end of the day Rationale: There are three distinct cleaning times for operating rooms: before the first case of the day, between cases, and at the end of the day. Before the first case of the day, horizontal surfaces in the operating room should be damp-dusted with a clean lint-free cloth or a wipe dampened with a disinfectant. After each case, EVS, nursing, and anesthesia personnel decontaminate horizontal surfaces, equipment, examination tables, anesthesia machines, medication carts, and other items used during a procedure. Personnel should pay particular attention to high-touch surfaces, taking care not to overlook machine controls, the tops of linen hampers, waste containers, computers, and phones. Cleaning of equipment should be delegated to personnel specifically trained to perform each task. Clean, lint-free cloths or disposable wipes should be used for each case. Cleaning cloths or wipes should be changed frequently and after contact with blood and bodyfluids. The cleaning process should progress from high to low and from clean to dirty. Items that are reprocessed, sharps, and biohazardous and nonbiohazardous waste must be placed in their respective containers and transported to their respective holding areas. Floors in the operating rooms must be cleaned and disinfected after each case. It is only necessary to clean a 3- to 4-foot perimeter around the operative table after each case unless wider perimeter of contamination is identified. At the conclusion of the operating schedule, blood spills and splatters not wiped up during the case must be cleaned and all items in the operating room decontaminated. Personnel should pay meticulous attention to high-touch surfaces. AORN recommends that floors be cleaned with a wet-vacuum and an EPA-registered disinfectant after the completion of scheduled cases. Ventilation grilles, shelves, and cabinets in the operating rooms should be cleaned routinely and when soiled. If not removed, dust and particles collecting in these areas can become airborne and be a source of contamination or infection. Scrub sinks, work rooms, utility rooms, and. corridors should also be thoroughly cleaned and disinfected regularly when operating room traffic is low, not in use, and/or whenever visibly contaminated. Reference: APIC Text, 4th edition, Chapter 107 -

Symptoms of inhalation anthrax include:

Fever and chills Chest discomfort Shortness of breath Confusion or dizziness Cough Nausea, vomiting, or stomach pains Headache Sweats (often drenching) Extreme tiredness Body aches

51. The organization that would most likely survey a U.S.-based hospital's blood bank for compliance would be: a. Occupational Safety and Health Administration (OSHA) b. Food and Drug Administration (FDA) c. Environmental Protection Agency (EPA) d. Centers for Disease Control and Prevention (CDC)

Food and Drug Administration (FDA) Rationale: The FDA is responsible for the safety of the nation's blood supply. The FDA has specific standards for collection, testing, and distribution of blood, as well as disposal of contaminated or untested blood. These standards apply to all facilities that have blood-banking operations. Re

62. Commercial third-party reprocessors are regulated by which government agency? a. Centers for Disease Control and Prevention (CDC) b. Environmental Protection Agency (EPA) c. Center for Medicaid/Medicare Services (CMS) d. Food and Drug Administration (FDA)

Food and Drug Administration (FDA) Rationale: When considering reprocessing SUDs, hospitals are faced with the decision whether to contract with a third-party reprocessor or formulate an in-house plan. No matter the approach, the process must comply with the FDA regulations. Reference: APIC Text, 4th edition, Chapter 32 -

97. The IP has identified poor compliance with hand hygiene practices in one of the critical care units. She has discussed her observations with the management of the unit and together they have identified a solution to improve practices. To ensure staff's adherence to the solution, in which of the activities below should the IP engage before implementing the solution? a. Perform a survey of fellow IPs to discuss the strategies they have found to be effective and that have sustained acceptable compliance b. Form a focus group of unit staff to discuss her observations, the ideas to improve compliance, and the proposed solution c. Develop a strategy with management to penalize any unit staff observed to be noncompliant d. Each month post the names of staff members she observes to be noncompliant with hand hygiene practices

Form a focus group of unit staff to discuss her observations, the ideas to improve compliance, and the proposed solution Rationale: Focus groups provide an opportunity for investigators to explore the beliefs of participants and provide an avenue for perceptions and concerns to be identified and addressed. Focus groups are a qualitative research method that can be used in quality improvement initiatives. For example, focus groups are used to obtain reactions to proposed changes or proposed solutions to problems, to describe perspectives that may differ from the researcher's, to describe relationships within groups (e.g., coping strategies), to assess programs and outcomes of services, and to confirm hypotheses. Reference: APIC Text, 4th edition, Chapter 19 - Qualitative

Describe Neisseria meningitides?

Gram negative cocci which is normal flora of the oropharyngeal

124. The IP has completed a series of education programs and summarized both the mean and standard deviation for four groups of participants. Which set of scores indicates the most consistent level of performance among the attendees? a. Group 1: Mean 88 SD 6.4 b. Group 2: Mean 87 SD 3.5 c. Group 3: Mean 90 SD 15.8 d. Group 4: Mean 92 SD 20.3

Group 2: Mean 87 SD 3.5 Rationale: Standard deviation is a measure of dispersion of the raw scores that reflects the variability in values around the mean. It employs the squared deviations from the mean (variance), which therefore gives added emphasis to larger deviations. The standard deviation indicates how small the variability is (i.e., the spread) among observations. If the variability is small, all the values are close to the mean. If it is large,' the values are not close to the mean. Group 2 has the smallest standard deviation, indicating less variability and thus greater consistency among the scores. Reference: APIC Text, 4th edition, Chapter 13

1. 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

Group B Streptococcus Rationale: In Group B Streptococcus (GBS) neonatal infections, 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 the vagina of a pregnant, asymptomatically colonized woman and subsequent rupture of membranes before 37 weeks' gestation. Reference: APIC Text, 4th edition, Chapter 94 - Streptococci

100. Which of the following has a low risk of transmission from sexual contact? a. Hepatitis B b. Hepatitis C c. HIV d. Syphilis

Hepatitis C Rationale: HCV is inefficiently transmitted by sexual intercourse (prevalence ranging from 1.3 percent in North America to 27 percent in Asia in long term partners), though homosexual men, persons with multiple sexual partners and HIV patients have higher rates of seroprevalence for HCV than monogamous heterosexuals. The average risk for vertical transmission is 6 percent overall and 17percent in mothers with HIV, which appears to be related to viral titer. No difference in transmission is noted whether the child is breast- or bottle-fed. Reference: APIC Text, 4th edition, Chapter 97 - Viral

64. A patient is suspected of having bacterial meningitis. A CSF sample was taken and had the following results: opening pressure was normal, glucose concentration was normal, lymphocytes were the predominant inflammatory cell, white blood cell (WBC) count was 88 per cubic mm, protein was normal, and the Gram and AFB stains were negative. Given these results, which of the following organisms could be the cause of the meningitis? a. Herpes simplex virus b. Haemophilus influenzae c. Mycobacterium avium d. Streptococcus pneumonia

Herpes simplex virus Rationale: The lumbar puncture (LP) is widely recognized as a necessary part of the early diagnostic evaluation of patients with suspected meningitis because the sensitivity of clinical symptoms, including the classic triad of fever, neck stiffness, and altered mental status exam, is low. CSF appearance, opening pressure (taken during this collection by using a simple column manometer; can be used for both fcir diagnosis and therapeutically), cellularity, biochemical evaluation, and Gram stain provide critically important diagnostic information as well as guidance for therapy. The preliminary CSF findings can provide keys to the diagnosis quickly and guide treatment for the patient and potential need for infection prevention precautions/isolation and prophylaxis for close contacts. The results of this CSF analysis and culture would rule out bacterial and fungal causes of meningitis, but a viral cause is possible.

9. Which of the following is the correct order for cleaning endoscopes? a. High-level disinfection, rinse the scope with sterile water, flush the channels with 70 to 90 percent alcohol, dry using forced air b. Rinse the scope using sterile water, high-level disinfection, flush the channels with 70 to 90 percent alcohol, dry using forced air Flush the channels with 70 to 90 percent alcohol, rinse the scope using sterile water, high-level disinfection, dry using forced air d. Dry using forced air, high-level disinfection, flush the channels with 70 to 90 percent alcohol, rinse the scope using sterile water

High-level disinfection, rinse the scope with sterile water, flush the channels with 70 to 90 percent alcohol, dry using forced air Rationale: Cleaning is essential before manual or automated disinfection. Thoroughly clean the entire endoscope immediately after use, then completely immerse the endoscope and endoscope components in the high-level disinfectant/sterilant and ensure that all channels are perfused. After high-level disinfection, rinse the endoscope and flush the channels with sterile, filtered, or tap water to remove the disinfectant/sterilant. Discard the rinse water after each use/cycle. Flush the channels with 70 to 90 percent ethyl or isopropyl alcohol and dry using forced-air. The final drying steps greatly reduce the possibility of recontamination of the endoscope by waterborne microorganisms. Reference: APIC Text, 4th edition, Chapter 55

Mumps communicability?

Humans are the only known natural host of mumps virus. Transmission is by droplet spread of respiratory secretions, via direct contact with infected fluids (primarily saliva or urine), and occasionally via fomites. The virus attaches to epithelial cells of the respiratory tract and replicates. The period of communicability begins 1 to 2 days (but can be up to 7 days) before onset of symptoms (e.g., parotid swelling) through 9 days thereafter

78. The manufacturer of a wound dressing product has notified the hospital's 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 dressings 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 Infection Prevention and Control Department c. Identify where the dressings 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 dressings 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 Rationale: The U.S. FDA is the federal agency that is responsible for promoting public health through a number of activities, including the reasonable assurance that (1) food is safe, wholesome, sanitary, and properly labeled; (2) human drugs are safe and effective; (3) medical devices intended for human use are safe and effective; and (4) public health and safety are protected from electronic product radiation. Recalls are actions taken by a manufacturer/distributor to remove a product from the market. Recalls may be conducted on a manufacturer / distributor's own initiative (voluntary recall), by FDA request, or by FDA order. According to the FDA, a recall is a removal or correction of a product that is (1) defective; (2) a potential health risk; or (3) in violation of FDA regulations. The first step that the IP should take is to identify where the dressings are in the hospital, immediately remove them, and return them to the manufacturer. It is critical to assess the patients who used the product for signs of infection. Reference: APIC Text, 4th edition', Chapter 106

132. Another name for "flash sterilization" is: a. Immediate-use b. High-level disinfection c. Low-level disinfection d. Ethylene oxide (ETO) sterilization

Immediate-use Rationale: Flash sterilization (flashing), a form of point-of-use processing, occurs immediately before use and close to the patent care area, where it* will be used. Reference: APIC Text, 4th edition, Chapter 106

120. The Joint Commission National Patient Safety Goal (NPSG) 7 focuses on the prevention of infections. The IP has been asked to help identify what education should be provided to the patients regarding prevention of SSI, CLABSI, CAUTI, and management of multidrug-resistant organisms (MDR0s). What recommendation is applicable to all of these issues and would apply to all patients receiving care in the hospital? a. Cough containment to reduce transmission of airborne pathogens b. Importance of hand hygiene and asking caregivers if they have washed their hands c. Mode of transmission of microorganisms from one area of the body to another d. Symptoms associated with infection and the need to report them to healthcare providers

Importance of hand hygiene and asking care givers if they have washed their hands Rationale: The Joint Commission's National Patient Safety Goal 7 emphasizes the importance of patient education concerning key topics such as SSI prevention, prevention of central line-associated infections, and the management of resistant organisms. All patients should be taught the concepts of hand hygiene, including when to use soap and water or alcoho based hand rubs. Patients should also be taught to ask their care givers if rhey have washed their hands prior contact with the patient. Reference: APIC Text, 4th edition, Chapter 18 - Patient

2. 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 authors' 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 factor 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 Rationale: Causal associations exist when evidence indicates that one factor is clearly shown to increase the probability of the occurrence of a disease. In a causal relationship, the reduction or diminution of a factor decreases the frequency of the disease being studied. The criteria currently used for causality were developed by Austin Bradford Hill and are known as Hill's criteria. These criteria use modern epidemiological methods to determine whether a factor is causal for a given disease. Strength of association is the first criterion: The incidence of disease should be higher in those who are exposed to the factor under consideration than in those who are not exposed; that is, the stronger the association between an exposure and a disease, the more likely the exposure is to be causal. The odds ratio is a statistical measure that gives us an indication of how strongly the risk factor is associated with the disease outcome. Reference: APIC Text, 4th edition, Chapter 10

19. Which of the following is not an Occupational Safety and Health Administration (OSHA) requirement for healthcare linens? a. Employers must launder all workers' personal protective garments or uniforms that are contaminated with blood or other potentially infectious materials (OPIM) b. Contaminated textiles should be bagged or Otherwise contained at their point of use c. In the laundry facility, positive pressure should be maintained in the area where contaminated textiles are received d. Wet contaminated laundry must be placed in leakproof and color-coded or labeled containers at the location where it was used

In the laundry facility, positive pressure should be maintained in the area where contaminated textiles are received Rationale: Laundry facilities must maintain negative pressure in the area where contaminated textiles are received compared with the clean areas of the facility. . Reference: APIC Text, 4th edition, Chapter 111

121. The viral load in a patient with HIV: a. Increases during the antiretroviral phase, decreases during asymptomatic HIV infection, then increases as the patient progresses to acquired immune deficiency syndrome (AIDS) b. Remains low during the antiretroviral phase, increases during asymptomatic HIV infection, then decreases as the patient progresses to AIDS c. Remains low during the antiretroviral phase, increases during asymptomatic HIV infection, then increases as the patient progresses to AIDS d. Increases during the antiretroviral phase, decreases during the asymptomatic HIV infection, and continues to decrease as the patient progresses to AIDS

Increases during the antiretroviral phase, decreases during asymptomatic HIV infection, then increases as the patient progresses to acquired immune deficiency syndrome (AIDS) Rationale: During the acute retroviral syndrome there is a hi6h level of HIV viremia with plasma HIV RNA titers of 105 copies per mL. Therefore, when a patient presents with signs and symptoms compatible with acute retroviral syndrome, the laboratory diagnosis is based on the determination of HIV RNA titers or viral load, not determination of HIV serology. Reference: APIC Text, 4th edition, Chapter 81 - HIV/AIDS

127. An outbreak of norovirus in a LTCF would most likely have an epidemic 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 Rationale: An epidemic curve gives a graphical display of the numbers of incident cases in an outbreak or epidemic, plotted over time. The form of the resulting distribution of cases can be used to propose hypotheses on the nature of the disease and its mode of transmission. A propagated source means that infections are transmitted from person to person in such a way that cases identified cannot be attributed to agent(s) transmitted from a single source. Propagated (continuing) source cases occur over a longer period than in common source transmission. Explosive epidemics resulting from person-to-person transmission mayoccur (e.g., chickenpox). If secondary and tertiary cases occur, intervals between peaks usually approximate average incubation period. Reference: APIC Text, 4th edition, Chapter 12

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 susceptible 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 they can furlough the employee for the appropriate amount of time Rationale: This is an appropriate follow-up in this example. Occupational Health will need to furlough the nurse for 7 days after he developed a rash. There is no risk of exposure to coworkers or patients because the employee was not in the facility during the period of contagion, so determining susceptibility of HCP and patients who had contact with the nurse and placing susceptible patients on Airborne Isolation would be unnecessary in this example. References: APIC Text, 4th edition, Chapter 86 - Measles, Mumps, Rubella; APIC Text, 4th edition, Chapter 100

122. A patient is concerned that there might be microbes in the facility that are resistant to the environmental disinfection products in use. How do you respond to this concern? a. Inform her that while microbes can develop resistance to antimicrobials, they cannot become resistant to disinfectants b. Assure her that the disinfection products in use are ones that microbes have not developed resistance to yet c. Inform her that while reduced susceptibility of microbes to disinfectants can occur, the antimicrobial level of disinfectants used is still sufficient to inactivate those microbes d. Assure her that your facility uses special environmental disinfection procedures for all antimicrobial resistant organisms

Inform her that while reduced susceptibility of microbes to disinfectants can occur, the level of disinfectant used is still sufficient to inactivate those microbes Rationale: As with resistance to antibiotics, microbes can develop altered sensitivity to environmental disinfectant products though spontaneous mutation in the bacterial genome, transmission of transposable resistance genes to the chromosome from a plasmid and vice versa, and transfer of resistance genes on plasmids between microbes. However, decreased sensitivity or increased tolerance to environmental disinfectant products does not render the microbes resistant to these products and the concentrations of product used in the healthcare facility remain cidal for even less sensitive organisms. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Page 28

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 healthcare worker's false fingernails c. Commercial powdered infant formula d. Respiratory transmission from a colonized family member or healthcare worker

Intravenous lipid infusions Rationale: M. furfur is fungemia that is most often associated with lipid infusions. Reference: Chapter 10

88. The laboratory runs a PCR test for MRSA. Both the positive and the negative controls amplify MRSA DNA. What can theIP conclude about this test? a. It is accurate because the positive control amplified MRSA DNA b. It is accurate because the negative control amplified MRSA DNA c. It is inaccurate because the positive control amplified MRSA DNA d. It is inaccurate because the negative control amplified. MRSA DNA

It is inaccurate because the negative control amplified MRSA DNA Rationale: PCR is an automated technique used to detect a target sequence of DNA that is unique to an organism. Positive and negative PCR controls are designed to monitor assay performance. The positive control is intended to monitor- for substantial reagent failure. The negative control is used to detect reagent or environmental contamination by either MRSA DNA or MRSA amplicons. The negative control should not produce any amplification signal. Amplification of MRSA DNA in this control indicates that there was contamination of the samples with MRSA DNA, so the test results are not accurate.

38. You are working with the antimicrobial stewardship program in your facility to educate providers on appropriate use of antimicrobials. Which of the following would be an accurate recommendation from your group? , a. Metronidazole is an effective antimicrobial to use for MRSA skin infections b. Consistent use of broad-spectrum antimicrobials regardless of-susceptibility results will help reduce antimicrobial resistance in the facility c. It is not always necessary to maintain antimicrobial concentration in the body above the level of the minimum inhibitory concentration of the pathogen being targeted d. Cefepime is only useful for gram-negative bacterial infections

It is not always necessary to, maintain antimicrobial concentration in the body above the level of the minimum inhibitory concentration of the pathogen being targeted Rationale: The minimum inhibitory concentration (MIC) of a drug is the lowest amount that can be used that will still be effective against the pathogen. The MIC is a quantitative measure of resistance of the microbe to a drug, obtained by some antimicrobial susceptibility testing methods, such as E-test. Drugs with concentration-dependent activity are most effective when they reach a high concentration in the blood over a short period of time. The concentration of these drugs will then fall below the MIC for a period of time but they are still effective, and they can be dosed once a day. This is in contrast to drugs with time-dependent activity that should be maintained Consistently in concentrations above the MIC in the system and are administered with multiple or continuous doses. Reference: Chapter 13 & 26

34. Between cases in the operating room, the floors must cleaned and disinfected as follows: a. Floors are only cleaned at the end of the day unless organic debris is present b. The entire floor must be flooded and cleaned between each case c. Spot clean the floor only if visible blood/body fluids d. It is only necessary to clean a 3 to 4 foot perimeter around the table, unless a wider contamination area is identified

It is only necessary to clean a 3 to 4 foot perimeter around the table, unless a wider contamination area is identified Rationale: Floors in the operating room must be cleaned and disinfected after each case. Reusable string or microfiber mops may be used in between cases and should be changed after each use. If a cotton mop and bucket system is used, a clean mop head and fresh disinfectant must be used for each case. It is only necessary to clean a 3 to 4 foot perimeter around the operative table after each case unless a wider perimeter of contamination is identified. Reference: APIC Text, 4th edition, Chapter 107 -

Measles is highly contagious and is spread by? What type of isolation is required? How long?

It is spread by large and small droplets. Susceptible patients who have been exposed to an individual with measles (contagious) should be placed in an airborne infection isolation room from the 5th to 21st day after exposure (regardless of whether they received measles vaccine or immunoglobulin for this specific exposure) or from the onset of symptoms until 4 days after the onset of the rash if the patient becomes ill.

125. The Infection Prevention Director is revising roles within the infection prevention team to better utilize individual skills and increase the effectiveness of the infection prevention and control program. By exploring ways to add responsibilities, to use additional skills and abilities, and to include more recognition, the director is accomplishing: a. Job enrichment b. Job enlargement c. Job intensification d. Job rotation

Job enrichment Rationale: Job enrichment is defined as a way to motivate employees by giving them more responsibilities and variety in their work. The concept was developed by American psychologist Frederick Herzberg in the 1950s. According to Herzberg, a well-enriched job should contain a range of tasks and challenges of varying difficulties, meaningful tasks, and feedback, encouragement, and communication. Allowing employees more control over their work can stimulate their desire to succeed. Reference: APIC Text, 4th edition, Chapter 5

Why should dialysis patient not access the subclavian?

KDOQI and CDC guidelines state that the preferred insertion site is the right internal jugular, and subclavian access should be used only when jugular options are not available and in patients who are not anticipated to need permanent vascular access. This is because of a greater incidence of central venous thrombosis and stenosis when the subclavian is used. The CDC also recommends that the patients with advanced kidney disease also not have subclavian catheters used in order to preserve future access sites.

List late signs of Lyme disease

Later Signs and Symptoms (days to months after tick bite) •Severe headaches and neck stiffness •Additional EM rashes on other areas of the body •Arthritis with severe joint pain and swelling, particularly the knees and other large joints. •Facial or Bell's palsy (loss of muscle tone or droop on one or both sides of the face) •Intermittent pain in tendons, muscles, joints, and bones •Heart palpitations or an irregular heart beat (Lyme carditis) •Episodes of dizziness or shortness of breath •Inflammation of the brain and spinal cord •Nerve pain •Shooting pains, numbness, or tingling in the hands or feet •Problems with short-term memory

65. The director of critical care has expressed a concern that there seems to be an increase in contaminated blood culture results in the ICU. An acceptable contamination level for blood cultures is: a. Less than 10 percent b.' Greater than 3 percent c. Greater than 5 percent d. Less than 3 percent

Less than 3 percent Rationale: Bacteremia is a significant cause of morbidity and mortality in hospitalized patients. Accurate and timely identification of the causative organism is imperative. Blood cultures are considered the "gold standard" in the diagnosis and treatment of bacteremia. However, the prognostic value of blood cultures is limited by contamination. Contamination, or false positive blood cultures, occurs when organisms that are not present in the blood are grown in culture. Blood culture contamination rates of less than 3 percent are desired. Reference: The Infection Preventionist's Guide to the Lab, Chapter: 3

133. Because of the potential for rapid spread, one confirmed case of this disease is considered an urgent public health situation, and the IP should immediately report suspected and confirmed cases to the health department: a. Chickenpox b. Influenza c. Measles d. Legionnaires' disease

Measles Rationale: Measles (rubeola, 7-day measles) is a distinct clinical syndrome with characteristic prodrome respiratory tract symptoms (cough, coryza, and conjunctivitis), followed by a febrile exanthem and a recovery period that includes a persistent cough for many weeks. Measles occurs throughout the world. It is one of the most highly contagious infectious diseases in humans. Reference: APIC Text, 4th edition, Chapter 86

Describe the 1st stage of measles symptoms?

Measles symptoms generally appear in two stages. In the first stage, which lasts 2 to 4 days, the individual may have a runny nose, cough, and a slight fever. The eyes may become reddened and sensitive to light, while the fever gradually rises each day, often peaking as high as 103° to 105°F. Koplik spots-(small bluish while spots surrounded by a reddish area) may also appear on the gums and inside of the cheeks.

12. A 16-year-old male is brought to the ER with a fever, and a wound on his left leg that is draining purulent material. He complains of swelling and pain. He is a quarterback on the high school football team and has several turf burns on both legs. Past medical history is insignificant. The culture grows gram-positive organisms in clusters. What is the most likely differential diagnosis? a. Parasitic infection b. Atypical mycobacterium infection c. Methicillin resistant Staphylococcus aureus d. Streptococcus pyogenes

Methicillin resistant Staphylococcus aureus Rationale: Athletes can contract CA-MRSA by close skin to skin contact, sharing athletic equipment, sharing towels, razors, or other personal items with someone who has an active infection or who is a carrier. Athletes may get abrasions from artificial turf; these abrasions may serve as an entry point for CA-MRSA. In the community, most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. They often first look like spider bites or bumps that are red, swollen, and painful. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair. Reference: APIC Text, 4th edition, Chapter 93

22. Which of the following is conducted to reduce construction hazard risk? a. Mitigation b. Preparedness c. Response d. Recovery

Mitigation Rationale: An ICRA is a multidisciplinary, organizational, documented process hat after considering the facility's patient population and program: • Focuses on reduction of risk from infection, • Acts through phases of facility planning, design, construction, renovation, facility maintenance, and • Coordinates and weighs knowledge about infection, infectious agents, and care environment, permitting the organization to anticipate potential impact. The ICRA elements are divided into three areas: processes for design, construction, and mitigation. Mitigation recommendations should address the following: • Patient placement and relocation. • Standards for barriers and other protective measures required to protect adjacent areas and susceptible patients from airborne contaminants. • Temporary provisions or phasing for construction or modification of heating, ventilation, air conditioning, and water supply systems. • Protection from demolition. • Measures taken to train hospital staff, visitors and construction personnel. Reference: APIC Text, 4th edition, Chapter 117

72. While caring for a patient with suspected or confirmed Ebola, if during patient care a partial or total breach in PPE (gloves separate from sleeves leaving exposed skin, a tear develops in an outer glove, a needlestick) occurs, the healthcare worker must: a. Quickly remove PPE to reduce the risk of exposure b. Immediately perform disinfection of gloved hands using an ABHR c. Move immediately to the doffing area to assess the exposure d. Immerse exposed areas with a bleach solution

Move immediately to the doffing area to assess the exposure Rationale: Prior to working with patients with EVD, all healthcare workers must have received repeated training and have demonstrated Competency in performing all Ebola-related infection control practices and procedures, and specifically in donning/doffing-proper PPE. While working in PPE, healthcare workers caring for patients With EVD should have no skin exposed. If during patient care a partial or total breach in PPE (gloves Separate from sleeves leaving exposed skin, a tear develops in an outer glove, a needlestick) occurs, the healthcare worker must move immediately to the doffing area to assess the exposure. Implement the facility exposure plan, if indicated by assessment.

What is non-categorical data?

Non-categorical data can count the events/occurrences but not the nonevents/non-occurrences (e.g., number of patient falls per 1,000 patient days). With non-categorical data, the number at risk can be identified, but the actual number of "no infections" or "no falls" among those at risk cannot be identified.

For acute hemodialysis, where access for less than 3 weeks' duration is anticipated, vascular access may be obtained using a?

Noncuffed or cuffed catheter. However, if a catheter must be used for access for longer than 3 weeks, a tunneled, cuffed venous catheter is recommended.

79. The greatest concern in an emergency situation involving a patient with nontraditional body piercing is: a. Bleeding from areas of high vascularity b. Hematogeneous spread of bacteria to other sites c. Not being familiar with the opening mechanism of the jewelry to be able to remove it d. Causing distress to the patient

Not being familiar with the opening mechanism of the jewelry to be able to remove it Rationale: It is becoming more common for HCP to provide care for patients with body jewelry, and it is sometimes unclear whether removal of the jewelry is necessary. Removal of these items is sometimes required for radiological purposes and removal is not usually difficult if the patient is able to assist with the opening mechanism. In an emergency situation, attempts at removal may cause unnecessary trauma to the site. Many HCP 6re unaware of the procedures for removing body piercing. In a survey of 28 accident and emergency doctors, only six were able to accurately describe the opening mechanisms of all three commonly used types of jewelry. Reference: APIC Text, 4th edition, Chapter 123

41. Which would be the most objective method to determine the need for education about hand washing for a group of employees on a unit? a. Observational studies b. Personal interviews C. Focus group discussions d. Test development

Observational studies Rationale: Methods that can be used to determine educational needs of the learner population include the following: • Learner self-assessment: The learner develops a self-achievement model and compares the current situation to the standard. • Focus group discussion: Learning needs are assessed in small groups with members assisting each other to clarify needs. • Interest-finder surveys: These are data-gathering tools, such as checklists or questionnaires. • Test development: Tests can be used as diagnostic tools to identify areas of learning deficiencies. • Personal interviews: The educator consults with random or selected individuals to determine learning needs. • Job analysis and performance reviews: These methods provide specific, precise information about work and performance. • Observational studies: Direct observation of personnel working can be performed by quality management analysts or IPs (e.g., hand-washing study in critical care units). • Review of internal reports: Incident reports, occupational injury and illness reports, and performance improvement studies can be reviewed to determine specific learning needs of healthcare providers Reference: APIC Text, 4th edition, Chapter 3 - Education

122. What type of surveillance is the monitoring of bloodstream infection rates? a. Outcome surveillance b. Mandatory reporting c. Process surveillance d. Combined surveillance

Outcome surveillance Rationale: Surveillance programs should measure outcomes of healthcare, processes of healthcare, and selected events of importance to the healthcare organization. Examples of outcome indicators that may be monitored include HAls (e.g., bloodstream, urinary tract, pneumonia, surgical site, conjunctivitis, upper respiratory tract, or local intravenous site); infection or colonization with a specific organism (e.g., C. difficile, MRSA, VRE, or other MDRO, RSV, or rotavirus); decubitus ulcers; phlebitis related to peripheral intravascular therapy; pyrogenic reaction or vascular access infection in hemodialysis patients; resident or patient falls; influenza or TST conversions in patients, residents, or HCP; and sharps injuries and blood/body fluid exposures in HCP. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance

Describe a Pareto chart?

Pareto charts are a series of vertical bars arranged and sorted in descending order of height from left to right with a cumulative percent line on the y-axis. Quality improvement and information technology specialists use Pareto charts to categorize data and compare units of data against the whole. Pareto charts allow a team to identify where their efforts will produce the greatest value, implying that 80 percent of benefit stems from 20 percent of causes.

What are the risk for pregnant HCP and Parvovirus B19?

Parvovirus B19 was discovered in 1975 and is the causative agent of erythema infectiosum (also known as fifth disease), a common childhood illness. This agent is of concern to pregnant HCP because B19 can cause infection of fetal red blood cell precursors and lead to severe anemia and high-output cardiac failure in the fetus, hydrops fetalis, and fetal death. Parvovirus B19 infection of patients with hemolytic anemia (e.g., sickle cell disease) can be associated with a transient aplastic crisis and with a prolonged anemia in immunodeficient hosts (e.g., HIV-infected patients, patients receiving chemotherapy). Droplet precautions are required.

76. A healthcare facility requires TB screening for all employees at time of hire using two-step tuberculin skin test (TST) with purified protein derivative (PPD). A newly hired employee has provided documentation of one negative TST from 6 months prior. Which of the following actions should the IP recommend? a. No additional TSTs are needed b. Place one additional TST and screen for symptoms c. Place two TSTs 1 week apart d. Obtain a chest X-ray on the employee

Place one additional TST and screen for symptoms Rationale: HCP with documentation of a previous negative TST within the prior 12 months should have a second TST placed and be screened for signs and symptoms of TB. The TST should be read in 48 to 72 hours. If negative, the employee is cleared for work. If the TST is positive, a chest x-ray should be performed. References:AP/C Text, 4th edition, Chapter 95

25. A patient tells his nurse that he thinks his apartment is infested with bed bugs. Upon examination, the nurse finds bites on the patient's legs. The nurse contacts you for direction. Your response to the nurse is: a. Assess the hospital room for mosquitoes b. Place the patient's belongings is a plastic bag and tie securely c. Request that the belongings be incinerated d. This might be a rash related to a new antimicrobial that the patient is taking

Place the patient's belongings in a plastic bag and tie securely Rationale: If bed bugs are suspected, the patient must be examined and his or her personal belongings should be placed in plastic bags that are tied securely closed or in other sealed containers. Environmental clutter should be removed and the area vacuumed, preferably using a HEPA-filtered vacuum. Reference: APIC Text, 4th edition, Chapter 107

How is pneumonic plague spread?

Pneumonic plague can be spread from person to person. Transmission occurs by respiratory droplets. Patients with pneumonic plague require Droplet Precautions. Special air handling or negative pressure rooms are not indicated. Droplet Precautions (in addition to Standard Precautions) require that patients be placed in private rooms or cohorted, wearing a mask when working within 3 feet of the patient (logistically, some hospitals may want to implement the wearing of a mask to enter the room).

74. An example of a molecular testing methodology is: a. Gram stain b. Culture c. Polymerase chain reaction (PCR) d. Point-of-care testing

Polymerase chain reaction (PCR) Rationale: Molecular testing methodologies have greatly enhanced the speed, specificity, and sensitivity of tests for clinically significant microbes. Examples of molecular testing methods are PCR, pulse field gel electrophoresis, Western blot assay, enzyme linked immunoassays, and molecular genotypic assays.

Propagated outbreaks are outbreaks in which the disease?

Propagates in one or more initial cases and then spreads to others, a relatively slow method of spread.

What is a cohort study?

Prospective study that is easier and cheaper than a randomized controlled trial. In prospective or cohort studies, data are gathered over time. In this study design, a group of subjects with a known exposure status for the risk factor(s) of interest are followed over time to determine which of the subjects develops disease. These subjects form a cohort going through time together. Experimental studies are also prospective in nature. Data are gathered as subjects move from the present into the future while being followed up by the researcher.

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, Rationale: The FDA is a public health authority. HIPAA regulations cover disclosure to the FDA of the minimum amount of information is. necessary to prevent or control disease. Chapter 8

128. An IP notes that there appears to be an increase in positive AFB results for a 2-week time period. She recalls that there had been a confirmed case of Mycobacterium tuberculosis in a college student at the beginning of the time period. In all, six patients have culture results that confirm TB. After conferring with the Microbiology supervisor, a break in the lab's procedure is identified. The buffer solution that is used in these tests was contaminated with the initial patient's TB. This conclusion is confirmed with polymerase chain reaction (PCR) testing of the isolates. What would this type of outbreak be called? a. TB outbreak b. Pseudo-outbreak c. Epidemic d. Propagated outbreak

Pseudo-outbreak Rationale: A pseudo-outbreak is defined as an episode of increased disease incidence due to enhanced surveillance or other factor not related to the disease under study. It is generally applied to situations in which there is a rise in test results (e.g., positive microbiology cultures) without actual clinical disease. Reference: APIC Text, 4th edition, Chapter 12

110. OSHA requires the use of engineering controls to prevent transmission of bloodborne pathogens in the healthcare setting. Which of the following is an example of an engineering control? a. Requiring Hepatitis B vaccination for all HCP with occupational exposure b. Providing eye protection for all personnel who have potential for exposure to bloodborne pathogens c. Implementing the use of Universal Precautions d. Purchasing self-sheathing syringes

Purchasing self-sheathing syringes Rationale: Engineering controls prevent transmission of bloodborne pathogens. These controls use technology to reduce and remove the potential for contact with sharp objects that may be contaminated with blood and body fluids. Examples of engineering controls include safety needles, retractable scalpels, and sharps containers. Engineering controls are only valuable if they are used correctly. Education about correct use of the technology is a key factor in reducing exposure to bloodborne pathogens.

128. What healthcare-associated viral outbreaks are most frequently reported among infants and children? a. Hepatitis A b. Coxsackie A c. Staphylococcus aureus d. RSV

RSV Rationale: RSV is one of the most important causes of respiratory tract infection in infants and the elderly worldwide. It is transmitted by direct and indirect contact. RSV is a major preventable HAI with frequent outbreaks that can lead to high mortality rates in healthcare facilities. Proper infection prevention measures, including hand hygiene, Standard and Contact Precautions, cohorting, and rapid diagnostic techniques are critical in controlling the spread of RSV in healthcare facilities. Reference: APIC Text, 4th edition, Chapter 41

129. Which of the following is not confirmatory of an active measles infection? a. Positive measles immunoglobulin M (IgM) b. Fourfold increase in measles immunoglobulin G (IgG) c. Positive measles PCR from a skin biopsy d. Rash in a patient nonimmune to measles

Rash in a patient nonimmune to measles Rationale: A specific diagnosis of measles usually can be made on the basis of clinical presentation alone because of the characteristic prodrome (cough, coryza, and conjunctivitis with or without Koplik spots) and febrile exanthem. Detection of measles virus or antigens in clinical specimens or tissue can establish a recent infection with the measles virus. Viral isolation is possible from respiratory secretions, blood, urine, and, in special circumstances, skin biopsy. Serologic testing may be used to confirm the clinical diagnosis of measles or to assess immunity. The presence of measles IgM antibody by enzyme immunoassay (EIA) confirms a diagnosis of recent measles. Measles specific IgM antibodies may not be present until 72 hours after the onset of the rash, however. Seroconversion or a fourfold increase in measles IgG antibody titer by EIA, hemagglutination inhibition (HAI), or neutralizing antibodies can also be used to confirm a recent measles infection. Reference: APIC Text, 4th edition, Chapter 86 -

49. An IP is carrying out a case-control study to find out whether patients of Surgeon A had a higher likelihood of SSI than the patients of Surgeon B. The data collected show that Surgeon A operated on 300 patients and Surgeon B operated on 350 patients. Of Surgeon A's patients, 25 developed an SSI. Of Surgeon B's patients, 50 developed an SSI. Which of the following 2 x 2 tables correctly presents this data? a. Exposed: with outcome: 25 and without outcome is 275 Unexposed: with outcome: 50 and without outcome is 300 b. Exposed: with outcome 300 and without outcome is 25 Unexposed: with outcome 350 and without outcome is 50 c. Exposed: with outcome 25 and without outcome is 300 Unexposed: with outcome 50 and without outcome is 350 d.

Rationale: A 2 x 2 or contingency table categorizes study subjects on disease and exposure status. Study subjects are classified as: A = number of people with both the disease and exposure B = number of people with the exposure but not the disease C = number of people with the disease but not the exposure D = number of people with neither the disease nor the exposure The layout is as follows:

81. The heating, ventilation, and air conditioning system will need to be shut down in one patient care unit of your hospital for repairs that are anticipated to take two hours. Which of the following protocols should be followed for this event? a. Relocate all patients to other units while the shut down is in progress b. Require all patients to wear a surgical mask while the shut-down is in progress c. Relocate immunocompromised patients if necessary and provide emergency back up ventilation or portable units for other rooms d. No protocol needs to be followed as the short shut down period will not affect any patients

Relocate immunocompromised patients if necessary and provide emergency back-up ventilation or portable units for other rooms Rationale: Any shut-down of the HVAC must be coordinated with Infection Control to protect patient safety. Immunocompromised patients should be moved from the area if possible and an alternate ventilation method (emergency back-up or portable ventilation) should be used to maintain proper air flow in all rooms, including airborne isolation rooms and protective environments. Infection preventionists should be aware of the potential for a burst of spores from the HVAC when it is brought back online. In addition, critical areas will need to be given time for the appropriate number of air changes per hour to occur before they can be put back into regular use.

30. A hospital has admitted an immunocompetent patient with localized herpes zoster. During unit rounds, the IP notes a sign on the door that says "No pregnant women." How should the IP best respond to this? a. Leave the sign on the door because the patient poses a high risk of disease transmission to pregnant women b. Remove the sign from the door but ask the charge nurse to not assign the patient to any pregnant HCP and to prevent pregnant visitors from entering the room c. Remove the sign from the door and place the patient on both Contact and Airborne Precautions d. Remove the sign from the door and ensure that all lesions are completely covered; Standard Precautions are sufficient to prevent the spread of the virus

Remove the sign from the door and ensure that all lesions are completely covered; Standard Precautions are sufficient to prevent the spread of the virus Rationale: According to CDC recommendations, following Standard Precautions and completely covering lesions are sufficient to prevent transmission of localized zoster to susceptible visitors and personnel. If a woman has a history of varicella-zoster infection or vaccination, her antibodies will protect her fetus from infection, so there is no risk for her to enter the room or care for the patient. Infection with zoster virus during pregnancy can be harmful to the fetus; however, all HCP should be immune to zoster through history of illness or through immunization upon employment. If unvaccinated or susceptible HCP at risk for severe disease and for whom vaccination is contraindicated (e.g., pregnant HCP) are exposed, the CDC recommends that those personnel receive VZIG after exposure. References: APIC Text, 4th edition, Chapter 80

31. Which of the following is not a component of the Needlestick Safety and Prevention Act? a. Provide safety-engineered sharps devices and needleless systems to employees to reduce the risk of occupational exposure to bloodborne diseases b. When selecting safety-engineered products, solicit input from employees who provide direct patient care and have a high risk of injuries from contaminated sharps c. Maintain a sharps injury log to record injuries from contaminated sharps d. Require the Hepatitis A vaccine for all employees who are at risk for occupational exposure

Require the Hepatitis A vaccine for all employees who are at risk for occupational exposure Rationale: Hepatitis A is spread person to person; occupational exposure generally does not increase HCP risk for Hepatitis A virus (HAV) infection. To be compliant with the Needlestick Safety and Prevention Act, healthcare facilities should: • Provide safety-engineered sharps devices and needleless systems to employees to reduce the risk of occupational exposure to blood borne diseases. • Solicit input from employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective safety-engineered products and work practice controls. • Document the solicitation of input in the exposure control plan. • Maintain a sharps injury log to record injuries from contaminated sharps. The injury log must contain the type and brand of product involved in the incident, the work area where the incident occurred, and an explanation of how the incident occurred. Reference: APIC Text, 4th edition, Chapter 7

3. After an incident in which human milk from one mother was mistakenly fed to another mother's infant, the infection preventionist (IP) is tasked with leading a team to determine why the event occurred and how it can be prevented from happening again in the future. This type of analysis is known as: a. Root cause analysis (RCA) b. Gap analysis C. Strengths-weaknesses-opportunities-threats, (SWOT) analysis d. Failure mode effect analysis (FMEA

Root cause analysis (RCA) Rationale: RCA, gap analysis, SWOT analysis, and FMEA are tools that can be used to improve quality. The RCA process takes a retrospective look at adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring. Gap analysis is a tool that is used to take an organization from a current state to a future state where organizational objectives are met. A SWOT analysis is a process where the organization or group assesses their own positive and negative points, outlines opportunities for improvement and growth, and lists any threats that might impede those opportunities. A FMEA can be used to identify potential system failures or errors before they occur. Reference: APIC Text, 4th edition, Chapter 16 - Quality

Rubella was first described in the

Rubella was first described in the German literature in the early part of the nineteenth century. Since that time, rubella has been clearly defined as a mild, self-limited viral exanthem with a potential to cause serious disease in the fetus. Isolation of the virus in 1962 was the first step in the development of a live-attenuated vaccine. The timing of the first isolation was remarkable because it shortly predated one of the most devastating worldwide pandemics of rubella in 1964 and 1965. In the United States alone, there were more than 12 million cases of rubella with greater than 20,000 cases of the congenital rubella syndrome (2,100 neonatal deaths).

67. Last year, a hospital identified 21 CLABSIs. Which type of chart would be most useful to provide feedback regarding the effectiveness of CLABSI reduction strategies? a. Control chart b. Pie chart c. Run chart d. Display of normal distribution and standard deviation

Run chart Rationale: Two common methods used to measure and plot variation in the process of care include run charts and control charts. A run chart is the simplest of charts. It is a single line plotting observed data over time. A run chart can help identify upward and downward trends, and it can show a general picture of a process. A control chart also plots a single line of data over time. However, control charts include upper and lower control limit lines with a centerline. Control charts,are more sensitive at detecting abnormalities than run charts but require at least 25 data points for reliability and validity. Run charts require at least 20 data points. With such a small number of observations in our data set, the run chart would be the most appropriate choice. Reference: APIC Text, 4th edition, Chapter 14 - Process

61. The IP is a member of an interdisciplinary team that has been given administrative oversight for its planning, activity scheduling, and expenditures under $500. This type of team is best described as: a. Cross-functional b. Virtual c. Autonomous d. Self-managed

Self-managed Rationale: Self-managed teams, also called self-directed teams, are small autonomous groups of employees who determine, plan, and manage their daily activities with little or no supervision. Self-managed teams offer cost savings and increased productivity.

81. The Infection Control Risk Assessment (ICRA) should include all of the following elements related to building design features except: a. Sewage systems to allow adequate sanitation of waste b. Location of special ventilation and filtration of heating, ventilation, air conditioning (HVAC) serving areas, such as ED waiting and intake areas c. Water systems to limit Legionella spp. and other waterborne opportunistic pathogens d. Air handling and ventilation for surgical services and airborne infection isolation (All)

Sewage systems to allow adequate sanitation of waste Rationale: Planning for new construction or major renovation requires early collaboration among IPs, epidemiologists, architects, engineers, and other stakeholders to ensure that design of specific structures facilitates desired infection prevention program practices. An essential first step in the planning process is ICRA, followed by interventions, monitoring, and continuous assessment and improvement at a broad, organizational program level and during operational projects. ICRA elements related to building design features include the following: • Numbers, location, and types of All and protective environment (PE) rooms • Location of special ventilation and filtration of HVAC serving such areas as emergency department waiting and intake areas • Air handling and ventilation needs in surgical services, All and PE rooms, laboratories, local exhaust systems for hazardous agents/chemicals, and other areas with special needs • Water systems to limit Leg/one//a spp. and other waterborne opportunistic pathogens • Finishes and surfaces Reference: APIC Text, 4th edition, Chapter 116 -

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 Control representatives say it is allowable d. Single-use items can be reprocessed in a third-party facility if FDA guidelines are followed

Single-use items can be reprocessed in a third-party facility if FDA guidelines are followed Rationale: The decision to reprocess and reuse a single-use item should be made by representatives from Administration, Risk Management, Legal Counsel, the supply chain administrator, and Infection Control. Third party reprocessors must be FDA-licensed to reprocess single-use devices. The reprocessing facility must maintain its own documentation, but it is recommended that the IP also review all documentation and records. Chapter 7

80. A patient in your facility has an infection with Cryptosporidium pan/urn. Which disinfectant would you recommend for use on potentially contaminated patient equipment? a. Ethyl alcohol b. Six percent hypochlorite c. Ortho-phthalaldehyde d. Six percent hydrogen peroxide

Six percent hydrogen peroxide Rationale: Cryptosporidium parvum are protozoa that are resistant to many disinfectants, including chlorine. The only disinfectant with known effectiveness against C parvum at working concentrations is hydrogen peroxide. Reference: CDC Guideline for Disinfection and Sterilization Disinfection, Asepsis"

38. 'A culture of a patient's dialysis access site grew Gram-positive cocci. One of the factors contributing to this type of infection is: j a. Contamination of the water used in dialysis b. Skin colonization with S. aureus at the access site c. Contamination of the antiseptic used to prep the access site d. Seeding of the access site by remote sites of infection

Skin colonization with S. aureus at the access site Rationale: Skin colonization with S. aureus at the access site has been significantly associated with S. aureus access site infections. Persistence of S. aureus after skin preparation has been shown to be significantly higher in patients with poor hygiene. The importance of personal hygiene and its possible relation to access site infections should be emphasized to patients. All patients should wash their access site with soap and water daily and before hemodialysis. Patients should also be instructed to ensure that all staff accessing the access site are preparing the skin appropriately prior to cannulation and wearing a mask for all access connections. Reference: APIC Text, 4th edition, Chapter 39 - Dialysis

14. Which of the following employee infections would require that the healthcare worker be restricted from patient contact? a. Sinus infection being treated by antibiotic b. Small, painful vesicular lesion on the fingertip c. Shingles, which has been treated with an antiviral for past 4 days d. Dry, crusted lesion on right arm with no new drainage

Small, painful vesicular lesion on the fingertip Rationale: Herpetic whitlow is a skin infection of the fingers, most commonly found on the tips of the thumb and index finger. Herpetic•whitlow is caused by the herpes simplex virus. Herpetic whitlow is common among HCP who come into contact with the virus regularly and in children who have the virus and suck their fingers or thumb. Recommendations from the Advisory Committee on Immunization Practices (ACIP) include restricting HCP with herpetic whitlow from patient contact and contact with the patient's environment until the lesions have healed. References: APIC Text, 4th edition, Chapter

6. A patient is admitted with fever, nausea and vomiting, sensitivity to light, and stiff neck. Symptom onset has been progressing slowly over several weeks. The Gram stain of the cerebrospinal fluid (CSF) is India ink positive, and there is low glucose and predominant lymphocytes. What type of precautions is required for this patient? a. Standard plus Droplet Precautions b. Standard Precautions c. Standard plus Airborne Precautions d. Standard plus Contact Precautions

Standard Precautions Rationale: Cryptococcosis is the most common fungal infection of the central nervous system. Cryptococcal meningitis is caused by the fungus Cryptococcus neoformans. This fungus is found in soil around the world. Cryptococcosis is believed to be acquired by inhalation of the fungus from the environment. Unlike bacterial meningitis, this form of meningitis comes on more slowly, over a few days to a few weeks. India ink will stain the polysaccharide capsule of C. neoformans, and C. neoformans meningitis is characterized by low glucose in the CSF and predominant lymphocytes. These results allow fungal meningitis to be distinguished from (1) bacterial meningitis,' which is characterized by fairly normal glucose levels and predominant neutrophils; (2) viral meningitis, which is stain negative with normal glucose; and (3) mycobacterial meningitis, which is AFB-stain positive. Meningitis with C. neoformans is not communicable so only Standard Precautions are needed in this case. Reference: APIC Text, 4th edition, Chapter 74 .

86. What species of the streptococci can be transferred to an infant during delivery? a. Streptococcus pyogeses b. Xanthomonas c. Streptococcus agalactiae d. Enterococcus faecalis

Streptococcus agalactiae Rationale: Asymptomatic carriage of Streptococcus agalactiae or group B Streptococcus (group B strep) in gastrointestinal and genital tracts is common. Intrapartum transmission via ascending spread from vagina occurs. Neurologic sequelae include sight or hearing loss and cerebral palsy. Death occurs in 5 percent of infants. Reference: APIC Text, 4th edition, Chapter 9 - Streptococci CBIC Core Competency: Identification of Infectious Disease Processes 87. 01, 3 Rationale: CHG products are increasingly used because of their effectiveness, 30-secOnd dry time, and low incidence of allergic reactions. CHG products do not need to be removed or rinsed from the skin following venipuncture. CHG is not approved for use with infants younger than 2 months of age. References: APIC Text, 4th edition, Chapter 24 -

116. Breaches in patient safety are being studied to determine the cause and effect of human error. Human factors engineering is a tool that: a. Studies processes to achieve "failure-free" operation over time to reduce defects and improve system safety b. Studies people at work, then designs tasks and the working environment so that people can be safe, effective, and productive c. Studies human characteristics and is concerned with design of tools, machines, and systems that take into account human capabilities d. Studies the elements involved with human-machine interface to improve working conditions

Studies human characteristics and is concerned with design of tools, machines, and systems that take into account human capabilities Rationale: Human factors engineering (HFE) involves research in human psychological, social, physical, and biological characteristics and is concerned with design of tools, machines, and systems that take into account human capabilities, limitations, and characteristics. The goal is to create designs that are safe, comfortable, and effective for humans to use. Reference: Chapter 18

Noninfectious postoperative endophthalmitis is most often associated with?

TASS, an acute, rapid onset of sterile anterior segment inflammation that mimics infectious endophthalmitis, most commonly occurs after cataract surgery. It is important to differentiate between the two because treatment, management, and patient outcomes differ. Delay in making a correct diagnosis can lead to delay in appropriate treatment and could result in vision loss or blindness. TASS cases were associated with breaches in handling, cleaning, and disinfecting of surgical instruments; introduction of contaminated solutions; contaminated intraocular lenses; toxic medications during surgery; and powder from gloves and irritants (dried blood, endotoxins, residual detergent) left on instruments

120. Several HOP have been exposed to a patient with untreated, active pulmonary B. Which is the best option for follow-up after this exposure? a. TSTs should be administered at the time of exposure; If these are negative, then no further follow-up is needed b. TSTs should be administered at the time of exposure and repeated at 12 weeks postexposure; converters without symptoms should be excluded from work and treated immediately c. TSTs should be administered at the time of exposure and repeated at 12 weeks postexposure; converters with symptoms should follow up with a chest x-ray d. TSTs and chest x-rays should be administered at the time of exposure and repeated at 12 weeks postexposure

TSTs should be administered at the time of exposure and repeated at 12 weeks postexposure; converters with symptoms should follow up with a chest X-ray Rationale: TSTs should be administered at the time of exposure tovestablish the baseline TST reaction. Follow-up TST should occur at 12 weeks postexposure to determine whether infection has occurred. If . HCP are symptomatic in conjunction with a TST conversion, they should be screened for active TB by chest X-ray. Reference: APIC Text, 4th edition, Chapter 100

Gap analysis is a tool that is used to?

Take an organization from a current state to a future state where organizational objectives are met

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 Rationale: Infection is the leading cause of morbidity and mortality in burn patients, despite improvements in care. Burns increase a patient's susceptibility to infection by damaging both the patient's physical and' immunological defenses. Skin is the largest organ of the body, and constitutes the first defense against infection. When burned, the integrity of the skin barrier is broken and normally sterile sites become vulnerable to microbes. Recent studies have shown an increasing prevalence of Acinetobacter, Klebsiella, and other Gram-negative rods in burn wounds. Although all of these above patient populations might be susceptible to Gram-negative rod wound infections, burn patients have the highest risk of Gram-negative wound infections, and therefore this unit is most susceptible to outbreaks 'with those organisms. Reference: APIC Text, 4th edition, Chapter:38 - Burns

5. A 47-year-old female bus driver is brought to the Emergency Department (ED) with a two-day history of fever, shortness of breath, and chest pain. She is diaphoretic and appears acutely ill. She is confused as to place and time. Temperature is 38°C (100.4°F), blood pressure is 88/60 mm Hg, pulse rate is 110/min, and respiration rate is 28/min. Coarse bronchial breath sounds are heard. She has had no recent known contact with ill persons. The leukocyte count is 15,000/QL (15 x109/L). A chest radiograph shows a widened mediastinum and bilateral pleural effusions. Gram stain of a peripheral blood smear shows' box car-shaped Gram-positive bacilli. A bioterrorism agent is suspected. Which of the following agents is most likely? a. Typhus fever b. Smallpox c . Tularemia d. Anthrax

The answer is Anthrax . Rationale: A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops. Bacillus anthracis, the bacteria that causes anthrax, is one of the most likely agents to be used in a biological attack because: 1. Anthrax spores are easily found in nature, can be produced in a lab, and can last fora longtime in the environment 2. Anthrax makes a good weapon because it can be released quietly and without anyone knowing. The microscopic spores could be put into powders, sprays, food, and water. Because they are so small, individuals may not be able to see, smell, or taste them. 3. Anthrax has been used as a weapon before There are three types of anthrax: cutaneous, gastrointestinal, and inhalational.

7. Which of the following processes should be used for contaminated endotracheal blades? a. Cleaning followed by high-level disinfection b. Cleaning with chlorhexidine followed by soaking in an enzymatic solution for 20 minutes c. Cleaning followed by ultrasonic washer d. Cleaning followed by alcohol disinfection

The answer is Cleaning followed by high-level disinfection Rationale: Semi-critical items are those items that will contact mucous membranes or nonintact skin. Respiratory therapy and anesthesia equipment, some endoscopes, laryngoscope blades, esophageal manometry probes, anorectal manometry catheters, and diaphragm fitting rings are included in this category. These medical devices should be free of all vegetative microorganisms (i.e., mycobacteria, fungi, viruses, bacteria), though small numbers of bacterial spores may be present. Intact mucous membranes, such as those of the lungs or the gastrointestinal tract, generally are resistant to infection by common bacterial spores but are susceptible to other organisms, such as bacteria, mycobacteria, and viruses. Semicritical items minimally require high-level disinfection using chemical disinfectants.

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. difficile c. The likelihood of having C. difficile 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 Rationale: Epidemiological studies can be divided by levels of data and analysis. The first level of distinction is between observational and experimental studies. Observational studies involve gathering data on existing subjects with no intervention. In experimental 'studies, the researcher provides one or more interventions and determines differences before and after the intervention. The simplest type of observational study is the descriptive study. This type of study seeks to describe a population in terms of person, place, and time: who gets disease, when, and in what kind of geographical location. Examples of "person" variables include age, sex or gender, occupation, marital status, ethnicity, and health status. These studies also describe "place" variables, such as urban/rural differences, socioeconomic differences across areas, interfacility locations, and others. For these studies; time may involve an epidemic period, month, quarter, season, or periods of consecutive years or months. Descriptive studies can be used to generate rates and identify populations at risk but cannot be used to show causality. Reference: APIC Text, 4th edition, Chapter 10

95. A used endoscope was placed in a carrying case before being cleaned and reprocessed. Which of the following actions should be taken? a. The endoscope should be cleaned and reprocessed and placed back in the carrying case b. The carrying case should be retained and only utilized for endoscopes that have not yet been cleaned or reprocessed c. The carrying case should be discarded d. The carrying case should be retained and only used for endoscopes that have been wrapped after cleaning and disinfection

The carrying case should be discarded Rationale: Of all medical instruments, endoscopes have the highest association with healthcare outbreaks. Endoscope carrying cases should not be used to store clean or dirty endoscopes. with in a healthcare facility. If an unprocessed endoscope is placed in a carrying case then the case should be discarded because of the potential for a clean endoscope to become contaminated through contact with the case. Reference: CDC Guideline for Disinfection and Sterilization

37. 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 is more accurate because it is prospective is not an advantage of a case control study. Rationale: Case-control studies collect data retrospectively. Retrospective studies are used to get information about past events and are subject to recall bias because they rely on the memory of subjects and others for information on exposure. Reference: APIC Text, 4th edition, Chapter 10

32. If chance is a likely 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 Rationale: 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 (probability) that a result did not occur by chance. Significance levels show how likely a result is due to chance. In statistics, if a result is significant, it means that it is not due to chance. If chance is a likely explanation for the difference between a sample statistic and the corresponding null hypothesis population value, then the difference is not statistically significant. Reference: Chapter 13 & 63

28. The Director of Infection Prevention and Control and her infection prevention staff have decided to develop a clinical practice guideline to decrease the rate of CLABSIs in their facility. The goal is to reduce variation in practice and improve clinical outcomes. Of the choices below, what is important to remember when developing this guideline? a. The guideline should be no more than two pages in length to ensure compliance b. The guideline should categorize and compare data against a unit of measurement c. The guideline should identify, summarize, and evaluate the highest-quality evidence and most current data in the literature d. The guideline should identify how process specifications change over time

The guideline should identify, summarize, and evaluate the highest-quality evidence and most current data in the literature Rationale: Clinical practice guidelines are evidenced-based standards, such as algorithms and consensus statements, that address reducing variation in practice and improving clinical outcomes. Reference: APIC Text, 4th edition, Chapter 16 - Quality

What is the mortality rate for pneumonic plague?

The mortality rate is nearly 100 percent in untreated cases and almost 60 percent even when treated. In a bioterrorism event, primary pneumonic plague is most likely to occur because it results from the inhalation of aerosolized bacterial particles

26. A p value expressed as p <0.01 indicates: a. The possibility of these results occurring by chance alone is very small, so therefore, the result is not significant b. The possibility of these results occurring by chance alone is less than 1 in 100 and, therefore, significant enough to prove causality c. The null hypothesis should be rejected and the alternative hypothesis should be accepted d. The null hypothesis should be accepted

The null hypothesis should be rejected and the alternative hypothesis should be accepted Rationale: A common use of statistics is hypothesis testing: The hypothesis is a statement of expected results. Hypothesis testing uses the distribution of a known area in the normal curve. It estimates the likelihood (probability) that a result did not occur by chance. First, a research or alternate hypothesis is formulated. The hypothesis states the expectation to be tested (e.g., Doctor A has a higher SSI rate than Doctor B). Then a statement that is opposite to the research or alternate hypothesis is developed (e.g., Doctor A has a lower infection rate than Doctor B). The latter is called the null hypothesis (Ho). The Ho is always stated to be rejected. The research or alternate hypothesis (Ha) is the desired result. Only two outcomes are possible with hypothesis testing. The level of significance is the probability value arbitrarily chosen by the researcher as the desired level of probability at which one may feel secure in rejecting the null hypothesis. This probability of rejecting a null hypothesis when it is true is the level of significance or a level. Most researchers use 0.05(5 percent) or 0.01(1 percent) values for a to minimize the chances of incorrectly rejecting the null hypothesis. This specified level states a sufficiently small likelihood that the given observation could occur by chance variation alone (e.g., 0.05 or a 1-in-20 chance). The p value is commonly compared to a, the specified significance level of the test. If a = 0.01, then a p value less than 0.01 would cause one to reject the null hypothesis, whereas a p value greater than 0.01 would cause one to fail to reject the null hypotheses. A p value expressed as p<0.01 indicates that we should reject the null hypothesis because there is sufficient evidence to support that sampling variation or chance is an unlikely explanation for difference between the null hypothesis and sample values. This does not prove that the null hypothesis is true. Reference: APIC Text, 4th edition, Chapter 13 - Use of

11. An IP wants to make external comparisons of the data collected relating to catheter-associated urinary tract infections (CAUTI) in the Intensive Care Unit (ICU). Which of the formulas below will allow the IP to accurately benchmark against nationally available data? a. The number of ICU patients with urinary catheters in a given month divided by the number of urinary tract infections identified in the same month times 1,000 b. The number of ICU urinary tract infections identified in a given month divided by the number of urinary catheter days in the same month times 1,000 c. The number of urinary catheters used in the ICU in a given month divided by the number of urinary tract infections identified in the same month times 1,000 d. The number of urinary tract infections identified in a given month divided by the total number of patient days in the ICU in the same month times 1,000

The number of ICU urinary tract infections identified in a given month divided by the number of urinary catheter days in the same month times 1,000 Rationale: Data should be expressed as rates or ratios that are calculated using the same methodology as a nationally validated surveillance system. This allows an organization to compare its rates with another organization or a recognized benchmark. The NHSN indicator for CAUTI measures the development of a urinary tract infection associated with the risk of an indwelling urinary catheter in a defined population. The CAUTI rate is calculated as (# CAUTIs identified ÷ # indwelling catheter days) x1,000. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance

105. ICRA elements related to building site areas affected by construction include all of the following except: a. Impact of potential outages or emergencies and protection of patients during planned or unplanned outages, movement of debris, traffic flow, cleanup, and testing and certification b. The number of containment cubes owned by the facility c. Impact of disrupting essential service to patients and employees d. Determination of specific hazards and the protection levels needed for each

The number of containment cubes owned by the facility Rationale: An ICRA must guide a strategic, proactive design to mitigate environmental sources of microbes, to prevent infectious hazards through architectural design (e.g., hand washing and hand hygiene stations, isolation rooms; Materials selection for surfaces and furnishings) and to provide control measures that mitigate potential contamination during actual construction or renovation (e.g., dust barriers, pressure differentials, protection of air handlers). ICRA elements related to building site areas affected by construction include the following: • Impact of disrupting essential services to patients and employees • Determination of the specific hazards and protection levels for each • Location of patients based on susceptibility to infection and definition of risks to each • Impact of potential outages or emergencies and protection of patients during planned or unplanned outages, movement of debris, traffic flow, cleanup, and testing and certification • Assessment of external and internal construction activities • Location of known hazards Reference: APIC Text, 4th edition, Chapter 116

135. The new IP for a LTCF assesses adherence to the facility's hand hygiene policies. In reporting her findings, she includes one of the following: a. The number of hand hygiene episodes performed by personnel divided by the volume of soap used in the facility b. The number of hand hygiene episodes performed by personnel divided by the number of patient days times 1,000 c. The number of hand hygiene episodes performed by personnel divided by the volume of alcohol-based hand rub d. The number of hand hygiene episodes performed by personnel divided by the number of hand hygiene opportunities by ward or service

The number of hand hygiene episodes performed by personnel divided by the number of hand hygiene opportunities by ward or service Rationale: The CDC guideline and The Joint Commission require that HCP adherence to recommended hand hygiene policies be monitored and that HCP be provided with information about their performance. Acceptable methods for measuring hand hygiene adherence include: • Periodically conduct an observational study to determine the rate of adherence (number of hand hygiene episodes performed/number of hand hygiene opportunities) by ward or service. In addition to monitoring the rate of adherence, facilities may also assess the quality of hand hygiene adherence (time spent per hand hygiene episode, whether soap was-used, etc.) . • Monitor the volume of specific hand hygiene products (e.g., soap, hand rub, hand lotion) used per 1,000 patient days • Monitor adherence to artificial fingernail policies

35. To calculate the catheter-associated urinary tract infection (CAUTI) rate for a unit for one 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 Rationale: There are three important aspects of the formula in determining the CAUTI rate: (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; and (3) the persons in the denominator should have been at risk of the event or occurrence (that is, number of patients with urinary catheters. Reference: APIC Text, 4th edition, Chapter 13 - Use

A SWOT analysis is a process where?

The organization or group assesses their own positive and negative points, outlines opportunities for improvement and growth, and lists any threats that might impede those opportunities.

114. A dialysis patient has recently tested positive for HBsAg. Previous tests have been negative. The manager is concerned that the patient may have been exposed during a treatment. Which of the following is the most likely explanation of the patient's positive test result? a. The patient is resolving an acute Hepatitis B infection b. The patient received a dose of Hepatitis B vaccine in the last 21 days c. The result is inaccurate d. The patient is immune due to natural infection

The patient received a dose of Hepatitis B vaccine in the last 21 days Rationale: HBsAg is a protein on the surface of HBV; it can be detected in high levels in serum during acute or chronic HBV infection. Care should be taken when testing for HBsAg because recent administration of Hepatitis B vaccine may result in positive HBsAg results for 7 to 30 days following vaccination. References: APIC Text, 4th edition, Chapter 97

36. Which of the following is an example of surveillance on a process indicator? a. The incidence rate of Clostridium difficile 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 in the Bone Marrow Transplant Unit Rationale: 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. Reference: APIC Text, 4th edition, Chapter 11

65. During an inservice for new employees, the IP describes how Hepatitis B and human immunodeficiency virus (HIV) are transmitted. A major difference in the epidemiology of the two diseases is: a. Presence of the causative agent in body fluids b. The ability of the diseases to be transmitted during sexual intercourse C. The risk of transmission through needlestick exposures d. The potential for airborne transmission

The risk of transmission through needlestick exposures Rationale: Infection with HBV is a well-recognized occupational risk for. HCP. The risk of HBV infection is primarily related to the degree of contact with blood in the work place and also the HBeAg status of the source person. The risk of developing clinical hepatitis if the blood was positive for both HBsAg and HBeAg has been estimated at 22 to 31percent. In contrast, the average risk of HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3 percent. Reference: APIC Text, 4th edition, Chapter 101 -

Describe the 2nd stage of measles symptoms?

The second stage begins on day 3-7 consists of a red blotchy rash lasting 5 to 6 days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities.

47. The biological indicator that was included in a steam sterilization load of non-implantable instruments has shown a positive result, as have biological indicators used in two additional follow-up tests of the sterilizer. The chemical indictor in the original load was reactive, as were the chemical indicators used in the followup tests. The log of all the runs indicates that the run conditions (temperature and time) were appropriate for the instrument load and there were no abnormalities in steam supply or electrical supply. Which of the following should be done next: a. The load should be released for use in the facility b. The sterilizer should be tested again with paired biological indicators from two different manufacturers c. The items from the load should be immediately recalled and reprocessed d. All items that were processed in that sterilizer since the time of the last negative biological indicator should be recalled and reprocessed.

The sterilizer should be tested again with paired biological indicators from two different manufacturers Rationale: Biological indictors included in steam sterilization loads may show a positive result if the sterilization parameters are not met; if there is contamination of the growth medium in the indicator; or if the indicator was not manufactured properly. With steam sterilization, the instrument load does not need to be recalled for a single positive biological indicator test, with the exception of implantable objects. The log should be checked to ensure that the sterilizer was used correctly and maintenance should be contacted to determine if there was an interruption to steam or electrical supply. If there is no indication of abnormalities, then the sterilizer should be tested again in three consecutive cycles using paired biological indicators from different manufacturers to account for a possible defective biological indicator. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Page: 76-78, 117

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 (CICU) 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 Rationale: A confounding variable is an extraneous variable (i.e., a variable that is not a focus of the study) that is statistically related to (or correlated with) 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 condition. Confounding can lead to the assumption-that there are differences that do not really exist or to the observation that there is no difference when one truly exists. In this example, older age is associated with the risk factor of a CICU stay and with the outcome of VRE infection. The authors did not adjust for age in their study, so the IP should be concerned that the reported association is confounded by age. Reference: APIC Text,,4th edition, Chapter 10

Epidemiology is the study of what?

The study of the frequency, distribution, cause, and control of disease in populations. Itforms the basis of all health-related studies. It provides the background for interventions to reduce transmission of infecting organisms, reduce the number of healthcare-associated infections, and protect healthcare providers from infection. Understanding the relationships of host, environment, and organism will aid the infection preventionist in designing studies to determine the cause of healthcare-associated infections and design interventions.

Why does the risk of infection related to circulatory access for hemodialysis varies with the type of vascular access used.

There is a sevenfold greater risk for bacteremia in patients with a dialysis catheter than in those with a primary arteriovenous (AV) fistula.

55. A paramedic has been exposed to a patient's blood. The patient is Hepatitis B e Antigen (HBeAg) positive and the paramedic is Anti-HBc and Anti-HBs positive. What is the risk of the paramedic acquiring Hepatitis B infection from the source patient? a. There is no risk of infection for the paramedic because he was previously infected and is now immune b. There is no risk of infection for the paramedic because the patient is not infected c. There is no risk of infection for the paramedic because he is immune due to vaccination d. There is a high risk of infection for the paramedic

There is no risk of infection for the paramedic because he was previously infected and is now immune Rationale: The patient is infected and can transmit Hepatitis B, but the paramedic has been previously infected and is now immune to Hepatitis B. Antibody to the Hepatitis B core antigen is made in response to actual infection with the virus and antibody to the HBsAg is made after the virus is cleared from the patient. Anti-HBs prevent the person from becoming re-infected. Reference: APIC Text, 4th edition, Chapter 101

107. The Standardized Infection Ratio (SIR) for CLABSIs in the ICU is 0.8. Which of the following is incorrect? a. There were more CLABSIs in the ICU than expected b. There were 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 more CLABSIs in the ICU than expected Rationale: If the SIR is less than 1, then there were fewer infections reported in 2011 than what we would have predicted given the baseline data. In other words, progress has been made since the baseline period. More infections than what would have been predicted given baseline data . Fewer infections than what would have been predicted given baseline, data Infections have been prevented since the baseline period, Infections have increased since the baseline period. 1 minus the SIR = percent reduction: SIR minus 1 = percent increase For example, the SIR of 0.80 means that there was a 20 percent reduction in 2011 from the baseline period. For example, the SIR of 1.25 means that there was a 25 percent increase in 2011 from the baseline period.

Describe the clinical features of pneumonic plague?

They are similar to symptoms for the other forms of plague: nonspecific influenza-like symptoms such as fever, chills, body aches, malaise, headache, and gastrointestinal distress such as nausea, vomiting, diarrhea, and abdominal pain. Patients typically, progress from feeling well to having severe pneumonia with cough, chest pain, shortness of breath, and stridor within 24 hours.

18. As the sample size increases, what tends to happen to the 95 percent confidence interval? a. The margin of error increases b. They become more precise c. They become wider d. They become less precise

They become more precise Rationale: Larger sample sizes generate narrower and more precise confidence intervals. There is an inverse square root relationship between confidence intervals and sample sizes. To cut the margin of error in half, the sample size needs to be quadrupled, approximately. Reference: APIC Text, 4th edition, Chapter 13 - Use of

57. Subjects are said to be randomly assigned when: a. They are assigned to experimental and control groups from a sample representative of the larger experimental group b. They have an equal chance of being assigned to either the experimental or the control group c. They are assigned to experimental and control groups so that the groups differ on a critical variable d. Both the researcher and the subject are blinded as to know whether the subject is in the control group or the experimental group

They have an equal chance of being assigned to either the experimental or the control group Rationale: Random assignment is a procedure used in experimental studies to create multiple study groups that include subjects with similar characteristics so that the groups are equivalent at the beginning of the study. Participants are assigned to an experimental treatment or program at random so that each individual has an equal chance of being assigned to either group.

What is Cryptococcal meningitis?

This fungus is found in soil around the world. Unlike bacterial meningitis, this form of meningitis comes on more slowly over a few days to a few weeks. Patients with cryptococcal meningitis do not require Isolation Precautions. Standard Precautions should be followed on all patients. The most common choice of antibiotics is amphotericin B.

119. An IP is reviewing the below data from a cohort study that examined the relationship between VRE colonization and long term care. What was the incidence density of VRE colonization in this study? a. Three cases/4 person-years b. Five cases/4 person-years c. Three cases/3 person-years d. Two cases/1 person-year

Three cases/4 person-years Rationale: Incidence density is the total number of new cases over the period of time that each participant was observed during the study period. In this table there are three new cases of VRE over the study period, so the numerator for the incidence density calculation is 3. Participants were observed for a total of four person-years (add up the number of months of observation of all study participants) so the denominator is 4 person-years. Reference: Chapter 13

56. What column lists the numerator for each category? a. Total number of patients screened b. Total number of patients in category c. High-risk category d. Rate of screening compliance

Total number of patients screened Rationale: The numerator is the actual number of patients screened. Basic Formula for All Types of Rates Rate = x/y x k Where x = The numerator, which equals the number of times the event (e.g., infections) has occurred during a specified time interval. y = The denominator, which equals a population (e.g., number of patients at risk) from which those experiencing the event were derived during the same time interval. k =,A constant used to transform the result of division into a uniform quantity so that it can be compared with other; similar quantities. A whole number (fractions are inconvenient) such as 100,1,000,10,000, or 100,000 is usually used (selection of k is usually made so that the smallest rate calculated has at least one digit to the left of the decimal point) or is determined by accepted practice (the magnitude of numerator compared with denominator). Reference: APIC Text, 4th edition, Chapter 13

33. Noninfectious 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) Rationale: Healthcare-associated endophthalmitis can be either noninfectious or infectious. Noninfectious endophthalmitis is an adverse event with several presenting causes, including retained lens material and other introduced toxic substances. Frequency is unknown, but occurrence is not rare. Noninfectious postoperative endophthalmitis is most often associated with TASS—an acute, rapid onset of sterile anterior segment inflammation that mimics infectious endophthalmitis. 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.

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 Rationale: 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. Typhus (Rickettsia prowazekii) meets the Category B criteria. Reference: Bioterrorism Agents. In: Brooks K. Ready

What are the symptoms of Typhus?

Typhus fever from Rickettsia prowazekii infection is a severe and occasionally fatal disease in humans.

94. In a case-control study of the association between exposure to long-term nursing care and the outcome of VRE colonization, the authors report an odds ratio of 2.3. How should this odds ratio be interpreted? a. The study is flawed because a relative risk (RR) should have been calculated b. The risk of being placed in long-term nursing care is 2.3 times higher for people with VRE than without VRE c. VRE cases have 2.3 times the odds of having had exposure to long-term nursing care than non-VRE cases d. There is no association between VRE colonization and exposure to long-term nursing care

VRE cases have 2.3 times the odds of having had exposure to long-term nursing care than non-VRE cases Rationale: A case-control study groups participants by their disease status (in this example, VRE-colonized cases or VRE-noncolonized controls) and looks retrospectively to determine whether they had an exposure of interest. The odds ratio that is calculated from a case-control study is the odds of the cases having had the exposure divided by the odds of the controls having had the exposure. Although this is often interpreted the same way as an RR, a case control study does not give information about risk because incidence rates are not calculated in this study design. The odds ratio is not the risk of developing the disease given the exposure, but rather the ratio of the odds of having had the exposure given the disease status. Reference: APIC Text, 4th edition, Chapter 13 - Use of

2. The most unlikely method of transmission of infection in a healthcare setting would be: a. Airborne b. Vehicle c. Vector d. Contact

Vector Rationale: Vectors, such as insects, may transmit infectious organisms in the healthcare setting; however, this method of transmission' is of less importance in most industrialized nations. External vector-borne transmission is the mechanical transfer of microorganisms by a vector, such as a fly on food. Internal vector-borne transmission involves transfer of infectious material directly from the vector into the new host, such as occurs in mosquitoes and malaria, fleas and plague, and louse-borne typhus. The vector may simply harbor the-infectious organism, with no biological interaction taking place, or the agent may actually undergo changes within the vector (e.g., malaria parasites require that part of their life cycle take place within a mosquito). Reference: APIC Text, 4th edition, Chapter 10

17. An IP conducts an audit of the kitchen at an acute care facility. Which of the following would be a concern? a. Food servers wearing a plain wedding band b. Vegetables stored below raw meat in the refrigerator c. Nonabsorbent cutting boards d. Food stored 6 inches above floor

Vegetables stored below raw meat in the refrigerator Rationale: Improper storage or environmental sanitation may introduce contamination or allow low microbial load to proliferate if not kept at appropriate temperatures. Food storage must be done in a systematic manner to ensure that all food safety requirements are met. Food must be protected from cross-contamination by separating raw animal foods during storage, preparation, holding, and display from raw ready-to-eat food, including fruits and vegetables, as well as cooked ready-to-eat foods per the FDA Food Code 3-302.11. Reference: APIC Text, 4th edition, Chapter 109

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 Rationale: Healthcare facilities that are considering contracting with a commercial third-party reprocessor must verify that reprocessing an SUD presents no greater risk to their patients' health and safety than using a new SUD. The decision to contract with a reprocessing company should be based on a thorough review and FDA approval of their 510(k) application. An onsite visit should be scheduled, with the opportunity to meet with personnel involved in the process, and a review of the company's policies. The visit should also include an opportunity to view the cleaning and decontamination, inspection and testing, and sterilization load preparation process, and to review quality control records. Reference: APIC Text, 4th edition, Chapter 32

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 easilyunderstandable?

Was the appropriate study design used and are the conclusions reasonable? Rationale: 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. Reference: Chapter 20

83. What is the first action HCP should take after a needlestick exposure? a. Contact the supervisor b. Contact Occupational Health c. Squeeze or milk the site d. Wash the affected area

Wash the affected area Rationale: The first action after exposure involves an immediate cleaning of the exposed/injured site. A soap-and-water hand wash should be performed to remove visible soil. Alcohol is virucidal, so an alcohol-based hand hygiene agent can be used after soap-and-water hand wash has been performed. Caustic chemicals such as bleach should)not be used in an attempt to disinfect or cleanse the skin. Squeezing or "milking" the injured site is not necessary. Once the area has been washed, evaluation by a skilled professional should besought. Reference: APIC Text, 4th edition, Chapter 81

85. The Director of Infection Prevention and Control is developing an educational program to provide annual bloodborne pathogen training to healthcare personnel in her facility. There are approximately 7,500 employees who need annual training, and her team of fi e 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 Rationale: Although each of the delivery methods listed has benefits, the best method in this case is web-based training. It is easy to deliver to a large number of people, flexible so that people with varied schedules can complete the training at a time that is convenient for them, and easy to track by having employees register for training through an online system. Assessments can be built into web-based training so that learners can evaluate their understanding of the training while it is in progress and demonstrate their mastery of the material at the end of the training session. Reference: APIC Text, 4th edition, Chapter,:3

115. A patient is admitted with fever, rash, headache, abdominal pain, vomiting, and muscle pain. The IP is aware that Rocky Mountain spotted fever is endemic in the area. The patient reports a recent camping trip with exposure to ticks. Which of the laboratory tests listed below should be ordered to detect and differentiate the appropriate antibodies in the serum? a. Blood culture b. Weil-Felix agglutination c. Sedimentation rate d. Cold agglutinin

Weil-Felix agglutination Rationale: Rocky Mountain spotted fever (RMSF) is a tickborne disease caused by the bacterium Rickettsia rickettsii. This organism is a cause of potentially fatal human illness in North and South America and is transmitted to humans by the bite of infected tick species. Weil-Felix agglutination is a test performed to differentiate rickettsial antibodies in the serum. This test can be useful in diagnosing RMSF. Reference: APIC Text, 4th edition, Chapter 25 - Laboratory

11. 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. White blood cell count c. Platelet (thrombocyte count) d. Red blood cell indices

White blood cell count Rationale: A white blood cell (WBC) count and differential provide information about the relative numbers (that is, the percentage) of each type of WBC. Evaluation of the WBC count can help to determine whether an illness has a bacterial or viral origin.

44. Which of the following scenarios would be most appropriate for immediate-use sterilization: a. The vendor brings the instrument for the procedure the 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 so 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 Rationale: Flash sterilization is a quick-steam sterilization cycle that does not use the full sterilization cycle of exposure and dry times. Exposure may be abbreviated in gravity steam sterilizers by eliminating wrapping material or using container systems that ensure that the steam has unrestricted access to the instruments. The Association of Perioperative Registered Nurses' (AORN) Recommended Practices ,are consistent with the Association of Advancement in Medical Instrumentation (AAMI), which recommended that flash sterilization should be used only when there is an.urgent need for the items. Reference: Chapter 68 .

96. A patient is receiving eye drops to treat conjunctivitis. The drops are only available in a multi-dose vials. Which of the following is/are acceptable practices for this use of this medication? 1) This vial of medication may not be used on multiple patients 2) This vial of medication may be used on multiple patients if it has not come into contact with tears or the conjunctiva 3) This vial of medication may be used on multiple patients if it is used within 28 days of being opened 4) This vial of medication should be stored away from the patient care area a. 1 b. 1, 4 c. 2,3 d. 2, 3, 4

a. 1 Rationale: Multi-dose eye drops or creams are not acceptable for reuse on other patients if they have been used on a patient with an infectious disease of the eye. If the patient does not have an infectious disease of the eye, then the multi-dose vial may be used for other patients provided that it has not come into contact with the conjunctiva or tears of a patient. This medication must be used within 28 days of being opened or per the manufacturer's recommendations. Multidose medications that will be used on more than one patient must be stored away from the patient care area. Reference: APIC Text, 4th edition, Chapter 64 -

34. Which of the following diseases are preventable by immunization? 1) Diphtheria 2) Varicella 3) Pertussis 4) Cytomegalovirus a. 1, 2, 3 b. 1, 2, 4 c. 1, 4, 5 d. 2, 4, 5

a. 1, 2, 3 Rationale: The ACIP immunization schedule for HCP includes vaccines for diphtheria, varicella, and pertussis. There is no available vaccine for preventing congenital (present at birth) CMV disease. However, a few CMV vaccines are being tested in humans, including live attenuated (weakened) virus vaccines and vaccines that contain only pieces of the virus. The Institute of Medicine has ranked the development of a CMV vaccine as a highest priority because of the lives it would save and the disabilities it would prevent. Reference: APIC Text, 4th edition, Chapter 100

79. The following factors should be considered when preparing the environment for an educational program: 1) Providing an atmosphere of mutual respect and support 2) Establishing a comfortable environment conducive to learning 3) Encouraging interaction by arranging desks in straight rows 4) Having a person control and troubleshoot the environment as needed a. 1, 2, 4 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 3

a. 1, 2, 4 Rationale: One of the most important roles of the educator is to provide an atmosphere of mutual respect, as well as one that is friendly, informal, and supportive. Eye contact, addressing students by name, listening without interrupting, and acknowledging the validity of problems or opinions expressed are characteristics of an effective educator,. The educator must also take steps to create an environment that is comfortable and conducive to learning. The learning space should be private and congenial with careful consideration to seating, room temperature, and lighting. There should be a contact person at the learning site to troubleshoot any facility or technical problems should they occur. The traditional classroom setup with straight rows of desks does not promote interaction. Reference: APIC Text, 4th edition, Chapter 3a.

41. Methods to prevent the transmission of C. difficile infections include: 1) Hand washing with soap and water 2) Environmental cleaning and disinfection 3) Closing the unit for deep cleaning 4) Laundry and waste management controls a. 1,2 b. 2,4 c. 1,3 d. 3,4

a. 1,2 Rationale: C. difficile is a Gram-positive, spore-forming anaerobic bacillus that produces two large toxins—A and B—that cause diarrhea and colitis in ( susceptible patients whose normal colonic bacterial flora has been disrupted by prior antimicrobial treatment. Measures directed at the interruption of horizontal transmission include barrier precautions (hand hygiene/washing, gloving, isolation, and cohorting), and environmental cleaning and disinfection. Reference: APIC Text, 4th edition, Chapter 72

84. Seventy-five patients were admitted to the Medical-Surgical ICU. Forty were on the surgical service and 35 were on the medical service. Fifteen patients developed a healthcare-associated MRSA infection. Nine of the patients with MRSA infection were on the surgical service. There were 230 patient days in the ICU for the surgical patients in January, and 325 patient days for medical patients. What was the overall MRSA attack rate? a. 20 percent b. 2 percent c. 53 percent d. 5 percent

a. 20 percent Rationale: An attack rate is a special form of incidence rate. It is not truly a rate, but a proportion. It is the proportion of persons at 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 and is used almost exclusively for epidemics or outbreaks of disease where a specific population is exposed to a disease for a limited time. The attack rate equals the number of new cases of disease (for a specified time period) divided by the population at risk for the same time period multiplied by 100. Attack rate is the same as incidence rate, except that attack rates are always expressed as cases per 100 populations or as a percentage. The attack rate for this scenario is calculated as follows: 15 divided by 75 x 100= 20 percent. Reference: APIC Text, 4th edition, Chapter 13

57. Which of the following statements about testing for statistical significance is true? a. A p value of 0.05 means that the probability that the observation occurred by chance alone is 1 in 20 b. A p value of 0.05 increases the likelihood of making a Type 2 error c. The size of the p value indicates the power of the results d. The research hypothesis is the basis of significance

a. A p value of 0.05 means that the probability that the observation occurred by chance alone is 1 in 20 Rationale: The level of significance is the probability value arbitrarily chosen by the researcher as the desired level of probability at which one may feel secure in rejecting the null hypothesis. When using sample data, it is not possible to be absolutely certain that the hypothesis being accepted is true. Therefore, a probability that the finding is due to chance is stated. This probability of rejecting a null hypothesis when it is true is the level of significance or a level. most researchers use 0.05 (5 percent) or 0.01 (1 percent) values for a to minimize the chances of incorrectly rejecting the null hypothesis. This specified level .states a sufficiently small likelihood that the given observation could occur by chance variation alone (e.g., 0.05 or a 1-in-20 chance). The researcher finds the appropriate rejection region for a test statistic at a given a level and rejects the null hypothesis for values of the test statistic that lie beyond the specified value. Simply stated, a level is the level of risk of being wrong that a researcher is willing to take. The p value is commonly compared to a—the specified significance level of the test. A p value of 0.05 indicates that the probability that the observation occurred by chance alone is 0.05 or 1 in 20) That is, a true null hypothesis will be rejected one out of every 20 times. Chapter 13

134. The IP must prepare a cost-benefit analysis (CBA) for the proposed purchase of a new electronic surveillance system for the hospital. Which statement about the CBA is correct? a. All measures are expressed in monetary (US dollar) terms b. Only costs are expressed in monetary (US dollar) terms c. CBA is never based on existing financial data d. The monetary value of possible benefits is often highly speculative

a. All measures are expressed in monetary (US dollar) terms Rationale: CBA-is a systematic method of estimating the strengths and weaknesses of alternatives that satisfy transactions, activities, or functional requirements for a business. It is a technique that is used to determine options that provide the best approach for adoption and practice in terms of benefits such as labor, time, and cost savings. CBAs can help determine which alternative is a sound investment or decision by comparing the total expected cost of each option against the total expected benefits. The comparison shows whether the benefits outweigh the costs and by how much.

39. During outbreaks, the CDC recommends that high-touch surface's in patient rooms be cleaned and disinfected: a. At least three times a day b. Hourly c. At least twice a day d. Only when soiled

a. At least three times a day Rationale: During outbreaks, the environment, especially high-touch surfaces, is heavily contaminated with microorganisms. High-touch surfaces include commodes, toilets, toilet handles, faucets, bathroom rails, bedrails, telephones, computers, and food preparation areas. The CDC recommends that these surfaces be cleaned and disinfected at least three times a day and that low touch surfaces be cleaned at least twice a day. Reference: APIC Text, 4th edition, Chapter 107

46. Of the recommendations for reprocessing flexible gastrointestinal endoscopes listed below, the one that is most strongly supported by well-designed experimental, clinical, or epidemiologic studies is: a. Cleaning of endoscopes is essential before manual or automated disinfection b. Brushes used to clean endoscopes should be thoroughly cleaned and disinfected or sterilized between uses c. Ultrasonic cleaning of reusable endoscopic components should be used to remove soil and organic material d. Routine environmental microbiological testing of endoscopes should be carried out

a. Cleaning of endoscopes is essential before manual or automated disinfection Rationale: Cleaning of endoscopes before manual or automated disinfection is a category"IA recommendation by the CDC's HICPAC and is critical for prevention of endoscopy-related HAIs. There is no strong evidence to show that cleaning and disinfecting brushes or that ultrasonic cleaning will prevent endoscopy-related HAls. These are both Category II recommendations. There is no recommendation for the use of routine environmental microbiological testing of endoscopes (see Table PE2-2).

58. An IP is writing instructional objectives for a learning module on catheter-associated bloodstream infections. He wants to focus on the cognitive level of "Analysis" from Bloom's taxonomy. Which of the following choices contains the verbs he should use to describe his learning objectives? a. Compare, discriminate, and differentiate b. Define, identify, and select c. Discuss, explain, and paraphrase d. Judge, summarize, and recommend

a. Compare, discriminate, and differentiate Rationale: Bloom's taxonomy was developed in the 1950s and is still used today to categorize ways of learning and thinking in a hierarchical structure. A revised model was developed in the 1990s to better fit ethicational practices of the 21st century. The "Analysis" level refers to the process of breaking material into constituent parts, determining how the parts relate to one another and to an overall structure or purpose through differentiating, organizing, and attributing. Applicable verbs include analyze, appraise, break down, calculate, categorize, classify, compare, contrast, criticize, derive, diagram, differentiate, discriminate, distinguish, examine, experiment, identify, illustrate, infer, interpret, model, outline, point out, question, relate, select, separate, subdivide, test. Reference: APIC Text, 4th edition, Chapter 3

118. The IP is helping develop a large-scale project to address SSIs. Which of the following tools will the IP utilize that helps secure expert judgment prior to launching the project? a. Delphi technique b. Peer review c. Fisher exact test d. Meta-analysis

a. Delphi technique Rationale: The Delphi technique is a structured communication method that solicits opinions from a panel of experts who answer questionnaires in two or more rounds. After each round, the responses are summarized and redistributed for discussion. The experts are encouraged to revise their earlier answers in light of the replies of other members of their panel. Common trends are identified, outliers are examined and a consensus is reached. Delphi is based on the principle that forecasts (or decisions) from a structured group of individuals are more accurate than those from unstructured groups. References: APIC Text, 4th edition, Chapter 5

90. The OR notifies the IP that a patient is scheduled for a brain biopsy. After reviewing the results of diagnostic tests, possible diagnosis, and the reason for biopsy, the IP assesses the patient to be high risk for Creutzfeldt-Jakob disease (CJD). The next step is to: a. Determine the instruments to be used and the processing to be done b. Notify the staff to quarantine the patient after the procedure c. Advise the OR staff to disinfect the instruments in the OR d. Incinerate all equipment used to perform the biopsy

a. Determine the instruments to be used and the processing to be done Rationale: The OR, Sterile Processing Department, and the IP should meet to review the policy and recommendations for 'disinfecting and sterilization of the instruments as outlined by the World Health Organization (WHO) and the CDC. Reference: APIC Text, 4th edition, Chapter 73

35. A patient with a confirmed diagnosis of varicella (chickenpox) is seen in a busy ED. The staff at the registration desk immediately placed a mask on the patient until he could be moved to a negative airflow room in the ED, where he then removed his mask. A pregnant environmental services (EVS) employee, who is nonimmune to varicella, enters the room before an isolation sign is posted. She spends 6 minutes in the room with the patient, who is no longer wearing a mask. Which of the following is the most appropriate postexposure response? a. Give the EVS employee VZIG and place off work from day 10 through day 28 b. Administer the varicella vaccine immediately and place employee off work from day 10 through day 21 c. Have the employee wear a mask from day 10 through day 21 after the exposure and watch for signs and symptoms of disease d. Give the EVS employee the vaccine and VZIG and keep off work from day 10 through day 28 after the exposure

a. Give the EVS employee VZIG and place off work from day 10 through day 28 Rationale: According to the recommended immunization practices by the U.S. Public Health Service's ACIP, varicella vaccine should not be administered to pregnant women because the possible effects on fetal development are unknown. The EVS employee should receive the VZIG, and she should be excluded from duty for 28 days.

68. Which of the following are allowed in an ICU or other unit with immunocompromised patients? a. Latex-free balloons b. Flowers in a vase c. Fresh fruit d. Fish tank

a. Latex-free balloons Rationale: Infectious diseases cause,significant morbidity and mortality in immunocompromised patients. Water is a reservoir for pathogenic microorganisms and can be a source for HAls. As organizations recognize the importance of care delivery sites as therapeutic environments, they may consider installation of features such as fish tanks, decorative water fountains, water walls, or other water features. In balancing the risk of adding a potential reservoir of waterborne opportunistic pathogens, the CDC Guidelines for Environmental Infection Control in Health-Care Facilities recommend facilities avoid placing them in patient care areas. It is well established that both potted plants and fresh flowers carry microbial flora that are pathogenic for the immunocompromised host. Fresh fruits and vegetables also carry several species of Gram-negative rods as part of their natural flora. Latex-free balloons are a safe choice in healthcare facilities. References: APIC Text, 4th edition, Chapter 23

76. The IP is asked to review with a group of staff nurses how to interpret antibiotic susceptibility tests. The susceptibility test that allows a determination of the least amount of antibiotic per milliliter that impedes the growth of an organism is known as: a. Minimum inhibitory concentration b. Kirby-Bauer disc method c. Minimum bactericidal concentration d. Serum cidal level

a. Mininium inhibitory concentration Rationale: Minimum inhibitory concentration is the lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation. Minimurn inhibitory concentrations are important in diagnostic laboratories to confirm resistance of microorganisms to an antimicrobial agent and to monitor the activity of new antimicrobial agents. Reference: Chapter 24

69. Case-control studies are useful for studying: a. Rare outcomes or outcomes that develop over a long time after exposure b. Individuals with and without exposure to a potential risk factor c. Specific exposure incidents d. The availability of a risk exposure

a. Rare outcomes or outcomes that develop over a long time after exposure Rationale: Case-control studies may be undertaken in a timelier and less expensive manner than prospective cohort studies because cases may be identified retrospectively, and at least some exposure data are often available through medical record review. Reference: APIC Text, 4th edition, 'Chapter 20

101. A biological indicator from one of the sterilizers in Sterile Processing turns positive. The first action should be: a. Retrieve unused items from the load b. Conduct surveillance of involved patients c. Evaluate the sterilizer d. Evaluate staff education of using the sterilizers

a. Retrieve unused items from the load Rationale: Recalling unused items would prevent further possibility of infection in patients and, therefore, should be done first. A written policy and procedure is needed to address who, when, and how to recall reprocessed items. Evidence of sterilization failures (e.g:, positive biological indicators) is the most common reason for a recall. In addition, the policy may include compliance components of the Safe Medical Device Act if failure is noted in the reuse of reprocessed items. At a minimum, a log of items within the sterilized load should be reviewed, unused items in the load should be retrieved for reprocessing, functional evaluation of the involved sterilizer should be completed, and surveillance of involved patients should be initiated. Reference: APIC Text, 4th edition, Chapter 106

107. Unused alcohol swabs that are placed on top of a dialysis machine in an active dialysis unit: a. Should be discarded b. May be returned to the common area c. Must be cleaned before being used on another patient d. Should only be used on patients with that dialysis machine

a. Should be discarded Rationale: There has been transmission of Hepatitis B and Hepatitis C in dialysis settings, which necessitates rigorous infection control practices. Any medications or patient care supplies such as tape., alcohol swabs, and syringes that come into contact with a dialysis machine should be discarded. Other items should be cleaned if possible before being returned to a common area or used on another patient. If cleaning is not possible, then those items should also be discarded. Reference: APIC Text, 4th edition, Chapter 39 - Dialysis

50. A patient who was recently vaccinated against smallpox has been admitted to a healthcare facility for a condition unrelated to the immunization. The charge nurse would like to know what type of precautions this patient needs. a. Standard Precautions b. Contact Precautions c. Droplet Precautions d. Contact and Airborne Precautions

a. Standard Precautions Rationale: Vaccinia virus is the poxvirus that is used to vaccinate against smallpox. The vaccine is a live vaccine that is administered using a bifurcated needle; a positive vaccine reaction results in a pustule at the vaccine site that lasts for approximately 30 days. Live virus can be transmitted through direct contact with the pustule or the scab that grows over it, but in a healthy person the pustule is limited to the vaccine site and is not widespread. The pustule should be covered with a bandage to prevent the patient from self-inoculating other sites of his own body. HCP should use Standard Precautions in this case, including wearing gloves to change the vaccine site dressing. Conditions directly related to immunization including eczema vaccinatum and generalized vaccinia warrant Contact Precautions until the immunization site has dried out and the scab has separated from the skin.

45. There is a flu outbreak in a community, and the IP at the local hospital is interested in accurately identifying infected patients as quickly as possible so that they can be placed on Isolation Precautions. The IP has a choice between two rapid flu tests. Test A has a sensitivity of 98 percent and a specificity of 85 percent. Test B has a sensitivity of 92 percent and a specificity of 89 percent. Which test will be most accurate in correctly identifying patients who are infected with flu? a. Test A, because it has higher sensitivity b. Test A, because it has a higher predictive value negative c. Test B, because it has higher specificity d. Test B, because it has higher predictive value negative

a. Test A, because it has higher sensitivity Rationale: Test A is the best choice. It will correctly identify 98 percent of people who have flu because it has 98 percent sensitivity. The specificity of Test A is 85 percent, So 15 percent of patients who do not have flu will be identified as positive (15 percent false positives [FPs]). In this case the IP is most interested in isolating infected patients, so the false-positive rate is an acceptable trade-off in this example. Reference: APIC Text,-4th edition, Chapter 13

56. A patient was admitted to the Emergency Department with severe headache, fever, and photophobia. The results of the lumbar puncture are pending. A staff member who cared for the patient is requesting antibiotics because the patient may have meningitis. If meningococcal meningitis is confirmed, chemoprophylaxis would be indicated for all of the following individuals except: a. The licensed practical nurse who did not have direct contact with the patient's oral secretions b. The emergency medical technician who performed mouth-to-mouth resuscitation c. The resident who did not wear appropriate PPE during intubation d. The registered nurse who suctioned the patient without wearing a mask

a. The LPN who did not have direct contact with the patient's oral secretions Rationale: HCP without direct exposure to the patient's oral secretions are considered low risk and chemoprophylaxis is not recommended.

10. Sensitivity may be defined as: a. The ability of a test to detect true positives (persons 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 positives (persons with the disease) when applied to a population with the disease Rationale: 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 out the disease. Reference: APIC Text, 4th edition Chapter 13 - Use of Statistics

93. The IP is designing a new hand hygiene intervention for HCP based on the Health Belief Model. According to that model, which of the following is/are examples of "modifying factors" in the hand hygiene intervention? a. The ages and genders of the people for whom the intervention is being designed b. Signs posted in the unit that remind HCP to perform hand hygiene c. The perception of how much time it will take HCP to perform hand hygiene compared to the potential for hand hygiene teprevent infection in patients d. The belief among the target audience that they will be able to comply with hand hygiene 100 percent of the time

a. The ages and genders of the people for whom the intervention in being designed Rationale: The health belief model (HBM) is the oldest theory specifically developed to understand and predict health-associated behavior. An IP can use this model as a theoretical framework to motivate and influence infection prevention behaviors of HCP. The HBM includes key components of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. According to the HBM, HCP would adhere to hand hygiene if they believed that they were susceptible to infection if they neglected to wash their hands. Education on infection prevention measures may influence HCP's perceived risk of contracting and spreading infection. HCP may perceive severity by understanding the serious consequences of infection caused by poor hand hygiene compliance, such as prolonged hospital stay, expensive medical cost, and increased morbidity. HCP may perceive benefits regarding the effectiveness of hand hygiene practice when it comes to decreasing infection among patients and thereby decreasing HCP's heavy workload. Reference: APIC Text, 4th edition, Chapter 5

125. Which of the following would be an acceptable use of immediateuse sterilization for a surgical instrument? a. To resterilize a surgical instrument that was dropped on the floor and for which no replacement is available b. To sterilize an expensive surgical tool so that additional tools do not need to be purchased c. To sterilize instruments that are not heat tolerant d. To sterilize an instrument quickly so that a surgeon does not have to wait for a replacement to be brought to the OR

a. To resterilize a surgical instrument that was dropped on the floor and for which no replacement is available Rationale: The Association for the Advancement of Medical Instrumentation (AAMI) defines immediate-use steam sterilization (IUSS) as the "Process designed for cleaning, steam sterilization, and delivery of patient care items for immediate use previously known as flash sterilization." The Association for Operating Room Nurses (AORN) states that IUSS should be kept to a minimum and should only be used in select clinical situations and in a controlled manner. IUSS should only be used when there is insufficient time to process the preferred wrapped or container methods intended for 'terminal sterilization, and it should not be used as a substitute for sufficient instrument inventory. Reference: APIC Text, 4th edition, Chapter 31

69. Which of the following educational tools is most effective to bridge the learning gap between theory and actual practice? a. Case stuay b. Lecture c. Computer-based training d. Game

a. case study Rationale: Case studies can be used as a training method to help bridge the learning gap between theory and actual practice. The method builds on a variety of learner skills: analytical, critical, and interactive. Learners explore multiple solutions and enhance creativity and problem-solving approaches often using a discussion-based format. Reference: APIC Text, 4th edition, Chapter 3

104. An IP has data on the number of bloodstream infections per central line days in the Cardiac ICU. This is an example of which type of data? 1) Discrete data 2) Categorical data 3) Non-categorical data 4) Continuous data a. 1,2 b. 1,3 C. .1,4 d., 2, 4

b. 1, 3 1) Discrete data 3) Non-categorical data Rationale: Discrete data contain whole numbers and are mutually exclusive (e.g., infected or not infected, male or female, blood type). Discrete data can be categorical or non-categorical. Categorical data can count both the number of events/occurrences and the number of non-events / non-occurrences (e.g., for 10 SS's in 100 surgical cases, there are 10 events [SSIs] and 90 nonevents [no SSIs]). Non-categorical data can count the events/occurrences but not the nonevents/non-occurrences (e.g., number of patient falls per 1,000 patient days). With non-categorical data, the number at risk can be identified, but the actual number of "no infections" or "no falls" among those at risk cannot be identified. Continuous data contain information that can be measured on a continuum or-scale and can have numeric values between the minimum and maximum value (a continuum) (e.g., age; serum cholesterol level; temperature, such as 98.6°F, 98.7°F, 'and 98.8°F; infection rates); continuous data require the process of measuring, rather than counting, and may contain whole numbers, decimals, or percentages. The type of data in this scenario is an example of both discrete data because it contains whole numbers and non-categorical data because it is only counting the events (i.e. infections), not the nonevents. Reference: APIC Text, 4th edition, Chapter 13 -

98. During routine infection prevention rounds in the Cardiac Catheterization Department, the IP notices that the air vents are dusty. The Nurse Manager is unsure of the cleaning schedule. The best action to take is: 1) Contact Environmental Services and request that the air vents be cleaned as soon as the room is available 2) Ask the nurse caring for the patient to dust the vents immediately 3) Reduce the number of air exchanges per hour until vent has been cleaned 4) Establish a monthly cleaning schedule a. 1,2 b. 1,4 c. 2,3 d. 3,4

b. 1,4 1) Contact Environmental Services and request that the air vents be cleaned as soon as the room is available 4) Establish a monthly cleaning schedule Rationale: Cardiac catheterization and associated diagnostic or therapeutic procedures bypass natural host defenses and thereby introduce the risk of infection. The air vent should be cleaned as soon as the room is empty , to reduce the exposure of the patient to organisms. Air exchanges should provide three fresh air per 15 total air exchanges per hour. The air vents should be cleaned at least monthly. Reference: APIC Text, 4th edition, Chapter 50

35. According to the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), which of the following groups should receive the Hepatitis B vaccine? 1) Unvaccinated adults receiving chemotherapy 2) Residents and staff of facilities for developmentally delayed disabled persons 3) People with more than one sexual partner 4) Unvaccinated adults <60 years of age with diabetes mellitus a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

b. 2, 3, 4 Rationale: Hepatitis B vaccination is the most effective measure to prevent HBV infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission, such as heterosexuals with multiple sex partners and men who have sex with men. Developmentally disabled persons in residential and nonresidential facilities also have had high rates of HBV infection, but the prevalence of infection has declined since the implementation of routine Hepatitis B vaccination in these settings. However, since Hepatitis B surface antigen-positive persons reside in such facilities, clients and staff continue to be at risk for infection. In response to multiple outbreaks of HBV among persons receiving assisted blood glucose monitoring, it is now recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type land type 2) be vaccinated against Hepatitis B as soon as possible after a diagnosis of diabetes is made.

95. A healthcare facility is experiencing its first case of carbapenemresistant Enterobacteriaceae (CRE) infection. The IP plans to intensify the facility's MDRO control efforts and is implementing an active surveillance culture (ASC) program for CRE. Which of the following strategies should the IP implement? 1) Screen all patients for CRE on admission 2) Place all colonized or infected CRE patients on Contact Precautions 3) Minimize invasive devices 4) Communicate results to healthcare providers a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

b. 2, 3, 4 Rationale: The emergence and dissemination of carbapenem resistance among Enterobacteriaceae in the United States represent a serious threat to public health. These organisms are associated with high mortality rates and have the potential to spread widely. Clinicians play a critical role in slowing the spread of CRE. Rapidly identifying patients colonized or infected with these organisms and placing them in Contact Precautions when appropriate, using antibiotics wisely, and minimizing device use are all important parts of preventing CRE transmission. Rather than screening all patients on admission, the CDC recommends focusing surveillance testing on patients admitted to certain high-risk settings (e.g., ICUs, long-term acute care) or specific patients (i.e., patients with risk factors, patients admitted from high-risk settings like long-term acute care or transferred from areas with high CRE prevalence). Reference: AP1C Text, 4th edition, Chapter 29

123. An IP has monitored the rate of hand hygiene compliance among different nursing units. She finds that the ICU staff's compliance is less than satisfactory even after providing conveniently located hand hygiene dispensers. She shares this feedback with the staff. Of the choices below, what other information should be included in her discussion with the staff to improve hand hygiene compliance? 1) The number of patients on the unit during the monitoring period compared to the number of staff, as well as the nurse to patient ratio 2) Information about hand contamination 3) Information about the association between hand hygiene practices and the transmission of infection 4) The effects of hand hygiene products on skin a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

b. 2,3,4 Rationale: To improve hand hygiene compliance, HCP should be provided with evidence-based information about hand contamination, the effects of hand hygiene products on the physiology of normal skin, and the association between hand hygiene practices and transmission of infection. The process of change is complex, and single interventions often fail; therefore, a multimodal, multidisciplinary strategy is necessary to change and improve hand hygiene practices.

121. Microorganisms are grown on culture media made of an agar base. Additives to media vary according to growth requirements of organisms and/or the desire to select out a specific organism. Fastidious organisms require____________________ media and ____________ media are used to inhibit normal commensals. 1) Differential 2) Enrichment 3) Selective 4) Nutrient broth 5) Synthetic sheep blood agar a. 1,3 b. 2,3 c. 3,4 d. 5,1

b. 23 2) Enrichment 3) Selective Rationale: A growth medium or culture medium is a liquid or gel designed to support the growth of microorganisms or cells. There are several categories of growth media, including (1) nutrient agar, a general-purpose growth medium that supports the growth of a wide variety of bacteria (e.g., trypticase soy agar with 5 percent sheep blood); (2) enrichment medium, which contains special nutrients necessary for the growth of hard-to-grow (fastidious) bacteria (e.g., chocolate agar for the growth of Neisseria meningitidis); (3) selective media that contain chemicals or antibiotics designed to inhibit normal commensals, allowing organisms of interest to grow (e.g., bismuth sulfate agar for the isolation of Salmonella spp.); and (4) differential media that promote the differentiation of specific organisms while inhibiting others (e.g., acetate agar to differentiate E. coli from Shigella). Reference: APIC Text, 4th edition, Chapter 24 - M

19. Which of the following is an example of an effective performance measure? a. A measure that has been developed based on observation of practices in a facility b. A measure that is based on a definition that can easily be understood and applied in a facility c. A measure that demonstrates a return on investment (ROI) d. A measure that takes into consideration customer satisfaction

b. A measure that is based on a definition that can easily be understood and applied in a facility Rationale: Performance measures should be evidence-based, well-defined,fclinically important for patient populations, and broadly applicable in different types of facilities. Selection of performance measures will be based on both external and internal measurement requirements. Reference: APIC Text, 4th edition, Chapter 17 -

20. The Product Evaluation Committee has asked the IP to assess a new preoperative skin preparation product that is less expensive than the one the facility is currently using. In researching the background information on the product, the IP reviews several sources of literature. Which of the following sources provides the best evidence for effectiveness of the product? a. The vendor representative's assurance that the new product has been tested and works at least as well as the product currently being used b. An independent, randomized trial that shows with statistical significance that the new product is comparable to the current product in preventing infections when used as a surgical skin prep c. The vendor-sponsored laboratory research showing that skin flora is reduced by the same magnitude with the new product as with the current product d. The testimonial of another IP whose hospital has been using the new product for 6 months

b. An independent, randomized trial that shows with statistical significance that the new product is comparable to the current product in preventing infections when used as a surgical skin prep Rationale: In randomized clinical trials (RCTs), the participants are randomly assigned to treatment or control groups to ensure that the allocation is unbiased. The RCT design minimizes bias and provides the best evidence for direct causal relationships between the experimental factor and the outcome. A randomized trial that was conducted by someone with no financial interest in the product and that was conducted under clinical conditions will provide the best evidence for effectiveness. Reference: APIC Text, 4th edition, Chapter 7

130. A facility has decided to engage in animal-assisted activities/ animal-assisted therapy, and the IP has been asked to develop infection prevention guidelines related to these activities. Of the choices below, which should be included in the guidelines? a. The types of animals visiting a patient must be limited to small dogs less than 20 lbs. with the proper temperament b. Animals must be screened to ensure that they are healthy and that their immunizations are current c. A patient's personal pet may interact with other patients d. Service animals may enter the operating room

b. Animals must be screened to ensure that they are healthy and that their immunizations are current Rationale: People benefit from the human-animal interaction socially, psychologically, and physiologically. In healthcare-related situations, programs for animal visitation, animal-assisted activities, animal-assisted therapy, and service animals are intended to assist in returning patients to wellness and independence. Healthcare facilities must establish animal and handler guidelines and program-specific infection prevention policies to provide a safe environment for animals, handlers, and patients. Infection prevention policies should stipulate that animals participating in animal-assisted therapy and interventions must be healthy and current with immunizations, including rabies vaccination and others required in the state in which the healthcare facility is located. An annual physical examination by a licensed veterinarian should include dental and dermatological evaluation. Animals should be free of communicable diseases and parasites and be on a flea control program prior to visiting. Animals participating is animal-assisted activities/animal assisted therapy must be screened and trained to ensure that they have the temperament to tolerate the equipment and environment in a healthcare setting. Personal pets should not be allowed to interact with other patients because of uncertainty regarding temperament and obedience. Service animals are not pets and are defined under the Americans with Disabilities act as "dogs that are individually trained to do work or perform tasks for a person with a disability." Hospitals may exclude service animals from areas such as ORs and burn units if the animal's presence could compromise a sterile environment. Reference: APIC Text, 4th edition, Chapter 122

37. While conducting rounds in the Intensive Care Unit (ICU), the IP is approached by a nurse who wants to know what the best practice standards are for drawing blood cultures from an existing central line. The correct response is: a. Drawing blood cultures from an established central line reduces the contamination rate b. Blood samples should be obtained in pairs (two sets) from different peripheral sites c. The site is unimportant as long as the hub is cleaned thoroughly d. The tip of the catheter is also cultured if bacteremia is suspected

b. Blood samples should be obtained in pairs (two sets) from different peripheral sites Rationale: Specimen collection from central catheters is not recommended due to the possibility of intraluminal bacterial contamination of the device. Percutaneous venipuncture from two separate sites is preferred.

75. Infection of short-term intravenous devices is associated with all of the following except: a. Percutaneous transmission during insertion b. Colonization of the catheter hub c. Extraluminal transmission d. Contamination of intravenous (IV) fluids

b. Colonization of the catheter hub Rationale: With short-term intravenous devices (IVDs) (in place fewer than 10 days), such as peripheral IV catheters, arterial catheters, and noncuffed, nontunneled CVCs, most device associatedbloodstream infections (BSIs) are of cutaneous origin, from the insertion site,-and gain access extraluminally, occasionally intraluminally. In contrast, contamination of the catheter hub and lurninal fluid is the predominant mode of BSI with long-term IVDs (e.g., in place more than 10 such as cuffed Hickman- and Broviac-type catheters, subcutaneous central ports, and PICCs. Reference: Chapter 34

36. When performing an audit of the Endoscopy Department, the IP observes the following practices. Which one is cause for concern? a. Single-use brushes are used to clean the scopes b. Equipment is immersed in enzymatic cleaner that is discarded every 24 hours c. Leak testing performed on scopes after each use d. Scopes stored vertically in a closed cabinet

b. Equipment is immersed in enzymatic cleaner that is discarded every 24 hours Rationale: Infection prevention is dependent on the education, training, and skill of the practitioner, the integrity of the device (ensuring that the equipment is free of defects), and strict adherence to reprocessing protocols. Flexible endoscopes are considered semicritical devices because they come into contact with mucous membranes but do not usually enter sterile tissue or the vascular system. Endoscopes should, at a minimum, receive high-level disinfection. Enzymatic detergents must be discarded after each use, as these products are not microbicidal and will not retard microbial growth. Reference: APIC Text, 4th edition, Chapter SS

100. One of the units in an LTAC facility is experiencing an outbreak of crusted scabies. In this situation, when is HCP prophylaxis indicated? a. Prolonged skin-to-skin contact with suspected and confirmed cases b. Evidence of infestation such as pruritic cutaneous rash c. All staff, volunteers, and visitors who may have been exposed to a patient with crusted scabies d. Treatment is indicated for all staff on affected units

b. Evidence of infestation such as pruritic cutaneous rash Rationale:. Control measures for an outbreak involving one or more cases of crusted scabies should involve rapid and aggressive detection, diagnosis, infection control, and treatment measures because this form of scabies is so highly transmissible. Unrecognized crusted scabies often is the source of institutional outbreaks of scabies. All staff, volunteers, and visitors who may have been exposed to a patient with crusted scabies, or to clothing, bedding, or furniture used by the patient, should be identified and treated. References: APIC Text, 4th edition, Chapter 100

105. Which of the following would be a good tool to prepare for a Joint Commission visit? a. Root cause analysis b. Gap analysis c. Multivoting d. Plan, Do, Study, Act

b. Gap analysis Rationale: Business and quality professionals describe a gap analysis as a technique to determine the steps to take to move from a current state to a desired future state. A gap analysis begins with: (1) listing characteristic factors, such as attributes, competencies, or performance levels of the present situation (what is); (2) listing factors required to achieve the future objectives (what should be); and (3) identifying the highlights or "gaps" that exist within the process and that must be filled to meet a goal or achieve standard compliance. Literature also refers to a gap analysis as a need-gap analysis, needs analysis, and needs assessment (see Table PE2-3 for sample).

82. A bacterium that is decolorized with alcohol during a Gram stain and retains the counterstain is: a. Gram-positive b. Gram-negative c. Stained purple d. Acid-fast positive

b. Gram-negative Rationale: In the Gram stain technique, bacteria are fixed on a Ode and a primary stain, crystal violet, is added to the slide. All bacteria will stain purple at this point regardless of their Gram-reaction category. Iodine is added to fix the crystal violet stain to the peptidoglycan layer of the cell wall of the bacteria, and then alcohol is used as a decolorizing agent. Gram-positive bacteria have a thick peptidoglycan layer that will retain the crystal violet stain even after alcohol is added, whereas Gram-negative bacteria have a lipopolysaccharide layer and a thin peptidoglycan layer. The lipopolysaccharide layer will be dissolved with alcohol and the peptidoglycan layer will be decolorized. The counter stain, safranin, will then stain the decolorized Gram-negative bacteria red; the Gram-positive bacteria will continue to appear purple. Reference: APIC .Text, 4th edition, Chapter 24

49. A healthcare worker has called the IP to ask the reasoning behind the policy that prohibits employees who have patient contact from wearing artificial fingernails. Which of the following reasons would she give to this employee? a. There is strong evidence that artificial nails are associated with HAls b. HCP with artificial nails are more likely to have more Gram-negative bacteria under their nails than HCP with natural nails c. Artificial nails often puncture gloves, exposing the healthcare worker to blood and body fluids d. HCP with artificial nails do not perform hand hygiene as often as HCP with natural nails

b. HCP with artificial nails are more likely to have more Gram negative bacteria under their nails than HCP with natural nails Rationale: Whether artificial nails contribute to the spread of HAls is unknown. However, HCP with artificial nails are more likely to harbor Gram-negative organisms on their fingertips than are those with natural nails. This holds true• both before and after hand washing. References: APIC Text, 4th edition, Chapter 27

8. A new Environmental Services employee has been asked to clean up a large blood spill on the floor in the OR. How should he proceed? a. He should mix an EPA-registered disinfectant with water in a bucket and mop up the spill b. He should place absorbent material over the spill and pour the correct dilution of disinfectant over the material for the recommended contact time c. He should pour undiluted bleach directly on the blood spill, wait 10 minutes, and then mop up the spill d. He should place absorbent material over the spill, dispose of the material after absorption, and then mop the floor with an EPA-registered disinfectant

b. He should place absorbent material over the spill and pour the correct dilution of disinfectant over the material for the recommended contact time . Rationale: Cleaning of a large blood spill may be a risk for acquisition of bloodborne pathogens, so immediate inactivation of any pathogens before cleaning is important to reduce this risk. Absorbent material may be placed over the spill to contain it and the correct dilution of an EPA registered disinfectant can be poured on the absorbent material to reduce the bioburden. After this, the absorbent materials can be gathered up and disposed of and the area can be cleaned. Reference: Chapter 107

23 An employee has experienced an accidental needlestick injury while providing care to a patient. All of the following lab tests 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

b. Hepatitis B antibody Rationale: A positive Hepatitis B antibody indicates past infection or immunity via vaccination. It does not indicate active infection. Reference: APIC Text, 4th edition, Chapter 101

13. An IP is assisting local public health with a Hepatitis A outbreak in the community. She has been asked to contact the Health Department with any patients who are admitted to her facility with a test positive for Hepatitis A virus (HAV). Patients who test positive in the acute phase of the illness will have a positive: a. Immunoglobulin G (IgG) anti-HAV b. Immunoglobulin M (IgM) anti-HAV c. Immunoglobulin A (IgA) anti-HAV d. IgG, IgM anti-HAV

b. Immunoglobulin M (IgM) anti-HAV Rationale: HAV is of the genus Hepatovirus in the family Picornaviridae of enteroviruses. It is a non-enveloped, 27-nm single-stranded RNA virus. HAV is transmitted primarily by the fecal-oral route, facilitated by intimate personal contact (household, sexual, etc.), poor hygiene, unsanitary conditions, or contaminated water, milk, or food, especially raw shellfish. Clinical features of acute hepatitis are not Specific for HAV infection, so serological diagnosis is necessary. Demonstration of the IgM antibodies against HAV (IgM anti-HAV) in the serum of acutely or recently ill patients establishes the diagnosis.

106. A patient has been admitted to an acute care facility with a diagnosis of rule-out pulmonary TB. Below is the lab report for the sputum testing on this patient. +++++Collection++++++++++++++++++++++++++++++++++AFB Stain ++++03/04 11:43 a.m.+++++++++++++++++++++++++Neg ++++03/04 08:26 p.m.++++++++++++++++++++++++Neg ++++03/05 11:13 a.m.++++++++++++++++++++++++++Neg Can this patient be removed from Airborne Precautions for rule-out pulmonary TB? a. Yes, the patient can be removed from Airborne Precautions, as TB can be ruled out b. No, the patient cannot be removed from Airborne Precautions, because he is infectious c. Yes, the patient can be removed from Airborne Precautions, as he has latent TB and is not infectious d. No, the patient cannot be removed from Airborne Precautions, because the sample collection was not sufficient to rule out pulmonary TB

b. No, the patient cannot be removed from Airborne Precautions, because the sample collection was not sufficient to rule out pulmonary TB Rationale: Sputum samples for AFB testing for active pulmonary TB must be collected between 8 and 24 hours apart and at least one sample must be an early morning sample. There must be three negative AFB stains to rule out communicable pulmonary TB. In this example the three sample collections are spaced appropriately but there was no early morning sample collected. Therefore, the patient cannot yet be removed from Airborne Precautions.

111. An IP is planning an educational program for hospital nursing staff to improve compliance with infection prevention strategies. Please choose the approach that should be used to ensure an effective learning experience for those who attend? a. Provide food and drinks to all who attend as well as sufficient breaks and have a raffle to entice attendance b. Plan the educational offering by developing goals and objectives and determining the teaching method to use c. Use a slide presentation that periodically provides humor to the presentation to ensure attention d. Provide continuing educational credits and handouts for future reference

b. Plan the educational offering by developing goals and objectives and determining the teaching method to use Rationale: The educator controls the learning experience with a well-defined plan using goals, objectives, and appropriate teaching methods. Goals are statements that communicate the intent of the curriculum and provide a direction for planning the education session. Expectations are clearly defined in terms of time and available resources. Reference: APIC Text, 4th edition, Chapter 3

99. Five cases of prosthetic valve endocarditis caused by Staphylococcus epidermidis are observed in one hospital. Of the following available methods, which is best for determining whether all five isolates were derived from a single source? a. Serotyping b. Pulsed-field gel electrophoresis c. Antimicrobial susceptibility testing d. Bacteriophage typing

b. Pulsed-field gel electrophoresis Rationale. Pulsed-field gel electrophoresis (PFGE) begins with the lysis of organisms and digestion of their chromosomal DNA with restriction enzymes. The fragments are separated into a pattern of discrete bands by switching the direction of the electrical current. This pattern serves as a "bar code" of the bacterial chromosome that can be used to assess the relatedness of different clinical isolates. This test method may be used with any organism from which chromosomal DNA can be properly isolated; it has been used with a wide variety of bacterial pathogens to assess epidemiological interrelationships. PFGE is probably the most widely used method for molecular epidemiology and is generally considered to be the gold standard for most clinically important organisms. Reference: APIC Text, 4th edition, Chapter 24

126. The IP has implemented a new educational program focusing on teaching safe injection practices to the staff nurses. Several months after the program is initiated, the IP is notified of a potential outbreak issue—a nurse used a medication vial for more than one patient. Which of the following quality tools would be most useful to investigate this incident? a. Value stream mapping (VSM) b. RCA c. SWOT d. FMEA

b. RCA Rationale: The RCA process takes a retrospective look at adverse outcomes and determines What happened, why it happened, and what an organization can do to prevent the situation from recurring. The RCA process avoids individual blame, considers human factors engineering, and analyzes redesign for a safer system. A thorough RCA determines (1) human and other factors; (2) the process or system involved; (3) underlying causes and effects of the process; and (4) the risks and potential contributions to failure or adverse results. , Reference: APIC Text, 4th edition, Chapter 16 -Quality

113. Which of the following processes should take place after an adverse event has occurred? a. Failure mode effect analysis (FMEA) b. Root cause analysis (RCA) c. Strengths-weaknesses-opportunities-threats analysis (SWOT) d. Infection control risk assessment (ICRA)

b. Root cause analysis (RCA) Rationale: The RCA process takes a retrospective look at adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring. A thorough RCA determines: (1) human and other factors; (2) the process or system involved; (3) underlying causes and effects of the process; and (4) the risks and potential contributions to failure or adverse results. Reference: APIC Text, 4th edition, Chapter 16

88. The IP Control Team has adopted the reduction of healthcare-associated MRSA as an annual goal. It has implemented improved processes and plans to monitor the effectiveness of these processes. Which of the following performance improvement tools will assist in identifying effectiveness? a. Affinity diagram b. Run chart c. Process flow chart d. Pareto chart

b. Run chart Rationale: Run charts are useful for identifying variations and trends, especially when assumptions for construction of control charts are not met. Run charts display observed data that can reveal trends or patterns over a specified period of time. They can be used with any type of data (discrete, continuous, etc.), and do not use any statistical calculations aside from measures of central tendency. They require at least 20 data points for reliability. Chapter 16

60. An IP is evaluating her control chart and notices that several points in a row are above the mean line. This probably indicates: a. The mean is incorrectly calculated b. She should investigate potential sources of special cause variation c. There is common cause variation in her process, and it requires no correction d. She is using the incorrect type of control chart

b. She should investigate potential sources of special cause variation Rationale: Statistical process control (SPC) is a method used to .monitor both processes and outcomes in a systematic and statistically valid manner. It is a decision-making tool that shows when a process is working correctly and when it is not. This information can then be used to improve quality. Control charts show if a process is in control or out of control. There are eight major rules used to detect special cause variation on a control chart: 1. Any point above the Upper Control Limit or below the Lower Control Limit 2. One of two points above +2 Standard Deviation (SD) or below -2 SD 3. Four of five points above +1 SD or below -1 SD 4. Eight consecutive points above or below the CL 5. Six consecutive points increasing or decreasing 6. Fifteen consecutive points between +1 SD and -1 SD 7. Fourteen consecutive points alternating up and down. 8. Eight consecutive points above +1 SD and/or below -1 SD

32. A patient is admitted to rule out TB. All of the following would be noted as a risk factor for transmission of infection to the staff except: a. Improper N95 respirator use by the staff b. Surgical mask placed on the patient during transport c. Acid-fast bacilli (AFB) smear positive sputum culture from the patient d. Patient placed in a regular exam room in the emergency room

b. Surgical mask placed on the patient during transport Rationale: The risk of infection transmission is related to the number of organisms that are aerosolized. Increased risk of infection is associated with patients with cavitary disease, smear-positive sputum, or a cough. Risk is also increased if patients are placed in poorly or improperly ventilated rooms. The emergency room (ER) and 'clinic areas should have plans for appropriately isolating patients with suspected TB who are being seen as outpatients. These plans'should include details on placing the patient in a separate area from other patients and placing .a surgical mask on him or her until appropriate isolation can be arranged. Reference: APIC Text, 4th edition, Chapter 95

86. The IP hears that one of the nursing units in his facility will soon be renovated. After verifying the information, he contacts the newly hired Director of Design and Construction to explain how important it is for the IP to be included in the planning and design of all renovation projects. Which of the following is the most compelling argument? a. The IP supplies necessary maintenance for critical utility systems that deliver ventilation and water to patient care areas b. The IP provides essential input into preventing hazardous risks to patients, HCP, and visitors during design and construction projects c. The IP will ensure compliance with various compliance, regulatory standard, and guideline-setting agencies d. The IP is responsible for facilitating the transport and approval for disposal of waste materials

b. The IP provides essential input into preventing hazardous risks to patients, HCP, and visitors during design and construction projects Rationale: A key element that !Ps bring to the construction and renovation process is creating an environment of care that supports prevention of infection and promotes safety of patients and personnel. Reference: APIC Text, 4th edition, Chapter 116

73. While making rounds on a nursing unit, the IP encounters a nurse who has just incurred a needlestick after giving an injection to a patient. The nurse tells the IP that the patient's recent laboratory results indicate that he has Hepatitis B, and the nurse has not completed her Hepatitis B vaccination series. She requests the IP's advice. In reviewing the patient's record, the IP finds that the patient's antibody to Hepatitis B is positive and his Hepatitis B surface antigen (HBsAg) is negative. The IP's explanation of the patient's laboratory results indicates which of the following? a. The patient is in the early incubation period of the disease and has a low probability of transmitting hepatitis B the nurse should report to Occupational Health b. The patient had Hepatitis B in the past and does not have active disease now; the nurse should complete her Hepatitis B series as scheduled, but no additional treatment is needed c. The results indicate a possible error in the results and another blood sample should be submitted d. The patient does have Hepatitis B but the disease is resolving; the nurse should report to Occupational Health

b. The patient had Hepatitis B in the past and does not have active disease now; the nurse should complete her Hepatitis B series as scheduled, but no additional treatment is needed Rationale: HBsAg-is a protein on the surface of HBV; it can be detected in high levels in serum during acute or chronic HBV infection. The presence of HBsAg indicates that the person is infectious. The presence of Hepatitis B surface antibody (anti-HBs) is generally interpreted as indicating recovery and immunity from HBV infection. This patient's surface antibody is positive and the surface antigen is negative, indicating that he is immune due to a natural infection. The nurse does not have to take any action. Reference: Chapter 101

31. The Director of Infection Prevention and Control has just received information about a bioterrorist threat in her county with an agent spread primarily by contaminated food/water. Which of the following agents should she include in her emergency response plan? a. Tularemia b. Vibrio cholerae c. Q fever d. Brucellosis

b. Vibrio cholerae Rationale: Bioterrorism refers to the use of biological agents on civilian or military populations, animals, or crops. There are a broad range of potential bioterrorism agents, including bacteria, viruses, and toxins (of microbial, plant, or animal origin). Common characteristics of this diverse group of agents include: (1) the ability to be dispersed in aerosols of 1 to 5 gm particles, which can penetrate the distal bronchioles; (2) the ability to deliver these aerosols with simple technology; (3) the feasibility of these agents, if delivered from a line source (e.g., an airplane) upwind from the target, to infect large numbers of the population; and (4) the ability to spread infection, disease, panic, and fear. The U.S. public health system and primary healthcare providers must be prepared to address various biological agents, including pathogens that are rarely seen in the United States. The CDC classifies high-priority agents as Category A.' This category includes organisms that pose a risk to national security because they have the following characteristics: • Can be easily disseminated or transmitted from person to person • Result in high mortality rates and have the potential for major public health impact • Might cause public panic and social disruption • Require special action for public health preparedness Second highest priority agents (Category B) include those that have the following characteristics: Are moderately easy to disseminate Result in moderate morbidity rates and low mortality rates Require specific enhancements of the CDC's diagnostic capacity and enhanced disease surveillance Reference: APIC Text, 4th edition, Chapter 120

33. In the event of a disaster with a prolonged power outage, how should you prioritize use of food stored in the facility? a. You should continue to use food from a variety of refrigerators and freezers as usual b. You should prepare food that is in unpowered refrigerators first c. You should prepare food that is in unpowered freezers first d. You should immediately use disaster reserve supplies

b.. You should prepare food that is in unpowered refrigerators first Rationale: In the event of an emergency where there is a power outage, the use of food should be prioritized to maximize supplies and to prevent the occurrence of foodborne illnesses. Food in an unpowered refrigerator should be used first because the temperature in this appliance will drop most rapidly below the critical temperature for food safety. If food is held at room temperature for more than two hours or above 90°F for more than an hour, it should be discarded because of the risk of microbial growth. Reference: APIC Text, 4th edition, Chapter 119 -

9. Which of the following statements is true regarding an asymptomatic employee with a newly positive tuberculin skin test (TST) of 10 mm induration in a medium to high risk setting? 1) The employee has latent tuberculosis (TB) infection 2) The employee is capable of transmitting TB to others 3) The employee is not infectious 4) The employee has TB disease a. 3,4 b. 2,4 c. 1,3 d. 1,2

c. 1 , 3 1) The employee has latent tuberculosis (TB) infection 3) The employee is not infectious Rationale: Latent tuberculosis infection (LTBI) is the presence of M. tuberculosis organisms (tubercle bacilli) without symptoms or radiographic or bacteriologic evidence of TB. Approximately 90 to 95 percent of those infected are able to Mount an immune response that halts the progression from LTBI to TB. Persons with LTBI are asymptomatic (they have no symptoms of TB) and are not infectious.

116. Primary components of an initial outbreak investigation are: 1) Preparing a line list and epidemic curve 2) Notifying key partners about the investigation 3) Continuing case finding 4) Initiating an analytic study a. 1,4 b. 2,3 c. 1,2 d. 3, 4

c. 1, 2 1) Preparing a line list and epidemic curve 2) Notifying key partners about the investigation Rationale: In general, outbreak investigations can be divided into two major sections, the initial investigation and the follow-up investigation, each with multiple components. The primary components of the initial investigation include the following: • Confirming the presence of an outbreak • Alerting key partners about the investigation • Performing a literature review • Establishing a preliminary case definition • Developing a methodology for case finding • Preparing an initial line list and epidemic curve • Observing and reviewing potentially implicated patient care activities • Considering whether environmental- sampling should be preformed • Implementing initial control measures Reference: APIC Text, 4th edition, Chapter 12

68. Which of the following would be evidence of CAUTI in an adult patient with an indwelling urinary catheter in place for more than 2 days? 1) Fever greater than 38°C 2) A positive dipstick for leukocyte esterase 3) A positive urine culture with 104 CFU/ml of E. coli 4) A positive urinary catheter tip for E. coli a. 1, 3, 4 b. 1, 2, 4 c. 1, 2, 3 d. 2, 3, 4

c. 1, 2, 3 1) Fever greater than 38°C 2) A positive dipstick for leukocyte esterase 3) A positive urine culture with 104 CFU/ml of E. coli Rationale: Virtually all healthcare-associated urinary tract infections are caused by instrumentation of the urinary tract. For patients with an indwelling urinary catheter at the time of specimen collection, NHSN criteria for a symptomatic urinary tract infection (SUTI) includes: Patient had an indwelling urinary catheter in place for > 2 calendar days, with day of device placement being Day 1, and catheter was in place on the date of event and At least 1 of the following findings: *Positive dipstick for leukocyte esterase and/or nitrite * Pyuria (urine specimen with 10 white blood cells [WBC]/mm3 of unspun urine or >5 WBC/high power field of spun urine) *Microorganisms seen on Gram stain of unspun urine and *A positive urine culture of 103 and <l05 CFU/mL and with no more than two species of microorganisms. Elements of the criterion must occur within a time frame that does not exceed a gap of one calendar day between two adjacent elements

61. Which of the following organisms are most likely to be the cause of outbreaks of healthcare-associated infections due to improper reprocessing of bronchoscopes? 1) Mycobacterium tuberculosis 2) Carbapenem-resistant Enterobacteriaceae 3) Pseudomonas aeruginosa 4) Staphylococcus aureus a. 1,2,3,4 b. 1,3,4, c. 1,3 d. 2,4

c. 1, 3 TB and Pseudomonas Rationale: Improperly processed bronchoscopes have been associated with outbreaks of infections in healthcare settings. These incidents have been due to inadequate cleaning of the scope, incorrect selection of disinfecting agents, and lapses in following the manufacturer's protocol for cleaning. The organisms that have been most highly associated with improperly processed bronchoscopes are Mycobacterium tuberculosis and Pseudomonas aeruginosa. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Page 15

67. Green cleaning is a new approach to environmental cleaning that aims at reducing harm to human health and the environment while maintaining or improving the hygiene of the healthcare environment. Which of the following green strategies would be appropriate to implement? 1) Replacing floor strippers and finishes that contain heavy metals and asthmagens 2) Substituting disinfectant room cleaners with less toxic detergents 3) Employing carcinogen-free carpet cleaners 4) Introducing high-filtration vacuum cleaners a. 1, 2, 4 b. 2, 3, 4 c. 1, 3, 4 d. 1, 2, 4

c. 1, 3, 4 1) Replacing floor strippers and finishes that contain heavy metals and asthmagens 3) Employing carcinogen-free carpet cleaners 4) Introducing high-filtration vacuum cleaners Rationale: The effective use of disinfectants is part of a multi-barrier strategy to prevent healthcare-associated infections. CDC Guidelines recommend that noncritical medical equipment surfaces should be disinfected with an EPA-registered low- or intermediate-level disinfectant. Current certification programs for green cleaning products and equipment do not cover EPA registered disinfectants. Reference: APIC Text, 4th edition, Chapter 107

15. 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

c. 1,2,4 Never flush with saline Rationale: Reprocessing contaminated equipment or instruments for sterilization begins at point of use. The end user is responsible for removing gross soil and debris and for rinsing items at the site of use. Instruments with lumens should be flushed with water (not saline, as salt is corrosive to most instruments). Every attempt should be made to keep instrument or equipment surfaces moist until they can be cleaned to facilitate the removal of soil. Applying enzymatic foam or gel cleaner, using wet towels placed within the set of used instruments, or presoaking used items in water or cleaning solution may also be done. Contaminated items should be placed in puncture-proof sealable containers and visibly labeled as bio-hazardous. Reference: APIC Text, 4th edition, Chapter 106 - Sterile Processing

66. Which of the sterility assurance levels (SAL) listed below is appropriate for critical items? a. zero b. 10-4 c. 10-6 d. 10-8

c. 10-6 Rationale: The sterility assurance level (SAL) is the probability of a microbe surviving on an item after sterilization. A SAL of 10-6 means that there is at most a 1 in one million chance of an organism having survived. This SAL is considered to be appropriate for critical items. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Page 101

39. In 2013, 3,254 persons died of all causes in a large metropolitan area with a population of 1.8 million. What was the crude mortality rate? a. 18 per 100,000 b. 18 per 1,000 c. 180 per 1,000 d. 180 per 100,000

c. 180 per 100,000 Rationale:- A mortality rate is the measure of the frequency of death in a defined population during a specified time (usually a year). The crude mortality rate measures the proportion of the population dying each year from all causes. The cause-specific mortality rate measures mortality from a specified cause for a population. Mortality rate = x/y x k Where: x = The number of people in a defined population during a specified interval of time who (1) die of any cause (crude rate) or (2) die of a specified cause (cause-specific rate) y = Estimated population at midyear (i.e., July); crude rates use 1,000 or 100,000 k = Usually an assigned value of 1,000 when calculating crude rates: 100,000 is used for cause-specific rates In this scenario the crude mortality rate is calculated as 3.254 +1,800,000 x100,000 =180 per 100,000 population. Reference: APIC Text, 4th edition, Chapter 13

64. Which of the following environmental infection prevention measures are recommended for inpatient units that house hematopoietic stem cell transplant (HSCT) patients? 1) Providing sterile linens 2) Prohibiting live plants and dried or fresh flowers in rooms of HSCT patients 3) Avoiding items that collect or trap dust 4) Providing laminar air flow a. 1,2 b. 3, 4 c. 2,3 d. 1,3

c. 2, 3 Rationale: Infectious 'complications are a common occurrence among patients receiving HSCT. Preventive measures should emphasize provision of a protective environment, appropriate use of prophylactic anti-infective agents, and meticulous attention to infection prevention practices, such as hand hygiene, device management, and the regulation of visitors. Furnishings and fixture in patient rooms should be easy to clean, and items that trap oi; collect dust should be avoided. Flowers/plants or their potting materials may harbor- large numbers of Aspergilluis spores and other microorganisms and should be restricted from the patient environment. Reference: APIC Text, 4th edition, Chapter 46

78. Poor planning during a construction project can lead to an increase risk of infection related to: 1) Construction delays 2) Compromised air quality 3) Contaminated water 4) Increase in construction-related traffic a. 1,3 b. 2, 4 c. 2,3 d. 1, 4

c. 2, 3 Rationale: Insufficient planning can lead to compromised air quality and potential for continued environmental contamination from fungi (e.g., Aspergillus spp.) or water contaminated with water-associated microorganisms (e.g., Leg/one//a spp.) during construction or renovation. Reference: APIC Text, 4th edition, Chapter 116

43. Event-related storage of sterile items allows packaged, sterile items to be used any time after processing provided that: 1) The expiration date has not passed 2) The packing wrapper is intact 3) The item has not gotten wet 4) The storage area is well-ventilated, dry, and free of dust and insects a. 1 b. 1, 2, 3 c. 2, 3, 4 d. 1, 2, 3, 4

c. 2, 3, 4 Rationale: Event-related storage of sterile items allows for items to be used at any time after processing, provided the sterile packaging has not been compromised. Items must be stored in a dry, well-ventilated, dust-free, insect-free, and temperature controlled area. Packages must be inspected before use to ensure that the wrapping is still intact, with no tears, punctures, or evidence of water intrusion.

114. What is the annual sharps injury rate per 100 full-time equivalents (FTEs) in a facility that has 18 sharp injuries and 800 full-time employees? a. 0.02 b. 0.23 c. 2.25 d. 22.5

c. 2.25 18/800X100=2.25 Rationale: A' rate measures the probability of occurrence (i.e., frequency) in a population of some particular event, such as cases of disease or deaths. A rate provides a means of comparing the occurrence of an event in one population to similar populations by adjusting for differences in population sizes. Basic Formula for All Types of Rates Rate = x/y x k Where: x = The numerator, which equals the number of times the event has occurred during a specified time interval. y = The denominator, which equals a population from which those experiencing the event were derived during the same time interval. k = A constant used to transform the result of division into a uniform quantity so, that it can be compared with other, similar quantities. A whole number (fractions are inconvenient) such as 100, 1,000, 10,000, or 100,000 is usually used (selection of k is usually made so that the smallest rate calculated has at least one digit to the left of the decimal point) or is determined by accepted practice (the magnitude of numerator compared with denominator). The annual sharps injury rate per 100 FTE in a facility that has 18 sharp injuries and 800 full-time 'employees is calculated as follows: (18 ÷ 800) x 100= 2.25. There are 2.25 sharps injuries per 100 FTE per year. Reference: APIC Text, 4th edition, Chapter 13 - Use of

131. The IP lives in a community of 100,000 persons. There have been more than 1,000 cases of Hepatitis C with 200 resultant deaths in l year. The case fatality rate for this is: a. 10 percent b. 800 per 10,000 c. 20 percent d. 200 per 100,000

c. 20 percent The CFR for this scenario is calculated as (200 +.1000) x100 = 20 percent Rationale: The case-fatality rate (CFR) is the proportion of persons with a particular condition (cases) who die from that condition. It is a measure of - the severity of the condition. The formula is: CFR = x/y x k Where: x = Number of cause-specific deaths among the ,incident cases y = Number of cause-specific deaths among the incident cases k = Usually an assigned value of 100 when calculating CFR A CFR is conventionally expressed as a percentage and represents a measure of risk. CFRs are most often used for diseases with discrete, limited time courses, such as outbreaks of acute infections. Reference: APIC Text, 4th edition, Chapter 13

22. Contact Precautions for a patient with scabies can be discontinued when the patient has received effective treatment for: a. 10 days b. 7 days c. 48 hours d. 24 hours

c. 24 hours Rationale: For hospitalized patients, Contact Precautions are required for 24 hours after the start of effective treatment. Twenty-four hours may be insufficient in cases of crusted scabies because viable Mites can remain on the patient after a single treatment; in this case an alternative isolation approach is suggested 'in institutional outbreaks: 10-day quarantine of the index patient. Text, 4th edition, Chapter 99 - Parasites

52. Diluted bleach solutions stored in an open container must be changed every: a. 30 days b. 28 days c. 24 hours d. 12 hours

c. 24 hours Rationale: If a diluted bleach solution is stored in an open container, the chlorine rapidly dissipates and therefore must be prepared daily. When stored in a spray or wash bottle or in a closed, brown opaque container, the bleach solution remains stable for 30 days and will retain 50 percent of its initial value. Reference:.APIC Text, 4th edition, Chapter 107

77. Under what circumstances should human immunodeficiency virus (HIV)-infected HCP be placed under work restrictions? 1) When viral burden measurements of <5 x 102 GE/mL for HIV infection and techniques for eliminating transmission risks cannot be identified 2) No work restrictions necessary if Standard Precautions are followed 3) When required by state or regional regulations 4) Whenever performing exposure-prone, noninvasive procedures 5) After counsel from an expert review panel is sought a. 2,5 b. 1,3 c. 3,5 d. 4,5

c. 3, 5 3) When required by state or regional regulations 5) After counsel from an expert review panel is sought Rationale: The CDC recommends that exposure-prone invasive procedures should not be performed by HCP with HIV until counsel from an expert review panel is sought. Risks during noninvasive procedures would be minimized with the use of Standard Precautions, but this may not be true for high-risk invasive procedures. An expert review panel can make these determinations and recommendations. State or regional recommendations must be followed. Reference: APIC Text, 4th edition, Chapter 100.

47. What is the negative predictive value of the following data? +++++++++++++++True Positive+++++++++++++++True Negative Positive:++++++++++++++100++++++++++++++++++++++++3+++++++++++ Negative+++++++++++++40+++++++++++++++++++++++500+++++++ a. 82.9 percent b. 83.3 percent c. 92.5 percent d. 71.4 percent

c. 92.5 percent Answer: 500 ÷ (40 + 500) = 0.9259 = 92.5 Rationale: The positive and negative predictive values are the proportions of positive and negative results in statistics and diagnostic tests that are true positive (TP). and true negative (TN) results. The negative predictive• value is the proportion of people with negative test results who do not have the disease. Negative predictive value := TN/(FN + TN) The negative predictive value for this question is calculated as follows: 500 ÷ (40 + 500) = 0.9259 = 92.5 percent Reference: APIC Text, 4th edition, Chapter 13

10. The lead IP is invited to participate in an employee health process improvement project. The goal of the project is to improve influenza vaccination rates among employees. A multidisciplinary team is formed with representation from front-line employees. After conducting a root cause analysis (RCA), the team develops a proposal for improvement to present to the facility leadership team. Which of the following elements should be included as part of the proposal to most clearly communicate to the leadership team the factors contributing to the facilities' current vaccination rate among employees? a. A timeline for implementing improvement activities b. A Pareto chart c. A fishbone diagram with an explanation d. A strategic plan

c. A fishbone diagram with an explanation Rationale: The RCA process takes a retrospective look at adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring in the future. The product of the RCA is an action plan that identifies the strategies that the organization intends to implement to improve safety. A thorough RCA demonstrates credibility of the recommended process to the facility leadership team. When used during the RCA process, a fishbone diagram (also called an Ishikawa diagram) will help identify and visually display both the elements involved in the improvement project and the areas of responsibility and accountability (see Figure PE3-3). Used in conjunction with the RCA, the fishbone diagram with an accompanying explanation present a clear picture of the both improvement project and rationale behind it.

83. Which type of room would be the most appropriate to place a patient who is immunocompromised and has disseminated herpes zoster disease? a. A shared, standard room b. A private, standard room c. An airborne infection isolation (All) room d. A protective environment room

c. An airborne infection isolation (All) room Rationale: Herpes zoster, also known as zoster and shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella (chickenpox). People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. The rash does not usually cross the body's midline. However, approximately 20 percent of people have rash that overlaps adjacent dermatomes. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster. This generally occurs only in people with compromised immune systems. Disseminated herpes zoster can be transmitted by an airborne route, so the patient needs to be placed in an airborne isolation room with negative airflow for the duration of the illness.

109. In preparing for the first meeting of the year for the Infection Prevention and Control Committee, the IP develops an annual report to include HAI trends. Of the choices below, this report should also address: a. A summary of injuries and risk factors for injuries in personnel during the previous year b. Staffing needs of the department to optimize efficiency c. An evaluation of the surveillance program providing an assessment of its usefulness to the healthcare facility in preventing and controlling infections d. A line list of all HAls for the previous year and risk reduction strategies

c. An evaluation of the surveillance program providing an assessment of its usefulness to the healthcare facility in preventing and controlling infections Rationale: An annual evaluation of the infection prevention program is important to outline achievements and activities of the program and describe support requirements. The value of the infection prevention program to the organization should be emphasized, along with patient outcomes and cost savings. Reference: APIC Text, 4th edition, Chapter 11

97. The IP has just reviewed the current public health recommendations concerning influenza vaccines before developing an educational program for employees. The report indicates that the most important problem in developing a long-term vaccine for influenza is: a. Potential toxicity of the vaccine if the dosage is increased b. Lack of potency c. Antigenic drift of the viruses d. Short storage life of the vaccine

c. Antigenic drift of the viruses Rationale: Antigenic drift refers to small changes in the influenza virus that happen continually over time. Antigenic drift produces new virus strains that may not be recognized by the body's immune system. When such a change occurs, people who have had the illness in the past will lose their immunity to the new strain, and vaccines against the original virus will also become less effective. Reference: APIC Text, 4th edition, Chapter 82

85. All of the following are examples of risk-adjusted stratification except: a. CLABSI rates by birth weight in the NICU b. Needlestick injuries by profession c. CAUTI rate for the ICU d. CLABSI rates by type of line

c. CAUTI rate for the ICU Rationale: Stratification is a form of risk adjustment that involves classifying data into subgroups based on one or more characteristics, variables, or other categories. For example, a measure's population might be stratified by gender before calculating rates, resulting in separate rates for males and females. In infection prevention, it is common to stratify infants by birth weight when assessing infections and infection risk or to stratify sharps injuries by time of day, role, and unit. Each subgroup becomes a separate denominator (population of interest), with the numerator event of interest the same for the subgroups; separate rates are then calculated for each subgroup. Reference: APIC Text, 4th edition, Chapter 17

63. Which of the following organisms is most likely to contaminate a urine specimen if the collection process is not done correctly: a. Staphylococcus aureus b. Pseudomonas aeruginosa c. Candida albicans d. Klebsiella pneumonia

c. Candida albicans Rationale: Fungi are eukaryotic organisms with cell walls containing chitin, cellulose, or both. Yeasts are unicellular organisms that reproduce by budding and typically, but not always, produce circular, mucoid colonies upon culture. Clinically, the most frequently isolated Yeasts are Candida, of which there are more than 80 species. Candida is a normal commensal of the human - gastrointestinal and female genital tracts. Reference: APIC Text, 4th edition, Chapter 78 - Fung

110. The IP has identified a cluster of Candida bloodstream infections in two adjoining ICUs. She wants to look at risk factors that these patients may have had in common. Which study design would she use? a. Cross-sectional study b. Cohort study c. Case-control study d. Clinical trial

c. Case-control study Rationale: A case-control study is designed to help determine if an exposure is associated with an outcome (i.e., disease or condition of interest). Case-control studies begin with the identification of persons who have the outcome of interest. Then a control group of individuals without the outcome is selected for comparison. For example, in a study to determine risk factors for healthcare-associated bacteremia, patients with bacteremia are identified and compared with a control group of hospitalized patients without bacteremia; medical records are reviewed to determine exposures to various factors, such as IV devices, invasive monitoring devices, prior infections, and immunocompetence. Reference: APIC Text, 4th edition, Chapter 20

24. 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. baumanii infection

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 Rationale: Confirming the presence of an outbreak is a key first step in an outbreak investigation. Chapter 12

16. An inspection of the Sterile Processing Department reveals several incorrect practices. Which of the following would be a correct practice? a. Ensuring hinged instruments are cleaned with the hinge closed b. Flushing instruments with saline c. Daily use of a biological indicator in the sterilizer d. Transporting contaminated instruments in a permeable container

c. Daily use of a biological indicator in the sterilizer Rationale: Steam sterilizers should be routinely tested at least weekly— preferably daily—with a biological indicator process challenge device. If a sterilizer is used frequently (e.g., several loads per day), daily use of biological indicators allows earlier discovery of equipment malfunctions or procedural errors and thus minimizes the extent of patient surveillance and product recall needed in the event of a positive biological indicator. Reference: Chapter 106

18. The Hemodialysis Department at a hospital completes a monthly water culture testing. The results are over the limit for colonyforming unit (CFU)/mL. Which of the following actions should be done first? a. Notify the physician b. Initiate daily water culture testing c. Disinfect the system d. Notify the Infection Control Department

c. Disinfect the system Rationale: According to the Conditions for Coverage document from Centers for Medicare & Medicaid Services (CMS), product water used to prepare dialysate or concentrates from powder at a dialysis facility, or to process dialyzers for reuse, shall contain a total viable microbial count lower than 200 CFU/mL and an endotoxin concentration lower than 2 EU/mL. Measures must be performed promptly when results exceed the action level or the maximum allowable level. Dialysis may continue when bacteria/endotoxin is found to be at the action level, but retesting and/or disinfection of the system should be performed promptly. Promptly has been defined by CMS regulation as within 48 hours of receiving the report. Reference: Chapter 39 American National Standards for Dialysate for Hemodialysis of less than 200 cfu/mL and an action limit of less than 50 cfu/mL and endotoxin of less than 2 EU/mL and an action limit of less than 1 EU/mL, respectively. Disinfection must be done at least monthly, but more frequent disinfection may be necessary to maintain viable bacteria and endotoxin levels below AAMI standards and is dependent on the quality of the water entering the system and the individual system design. Disinfection schedules should be designed to prevent bacterial growth rather than eliminate it when bacterial contamination over the limit is detected.

24. Which of the following statements is correct regarding the efficacy of a disinfectant product on a microbe? a. For all disinfectants, the greater the concentration of the disinfectant, the shorter the contact time is for effective cidal activity b. For all disinfectants, the activity of the disinfectant increases as temperature increases c. For all disinfectants, the greater the number of microbes on an object or surface, the greater the amount of time that's needed for a disinfectant to have effective cidal activity d. For all disinfectants, the existence of a biofilm does not affect cidal activity

c. For all disinfectants, the greater the number of microbes on an object or surface, the greater the amount of time that is needed for a disinfectant to have effective cidal activity Rationale: Without exception, a higher bioburden of organisms on an object or surface will require higher contact time for a disinfectant to kill the organisms. Prior cleaning of a surface or instrument will reduce the bioburden, which will decrease the necessary contact time for the disinfection process. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Page: 33-35

42. The IP is selecting a process measure in order to monitor and evaluate quality of care. An example of a process measure is: a. SSI after a hip replacement b. Conjunctivitis c. Hepatitis B immunity rates d. Tuberculin skin test (TST) conversions

c. Hepatitis B immunity rates Rationale: Process measures are commonly used to evaluate compliance with desired care or support practices or to monitor variation in these practices. They may also be used when the outcome to be measured is rare or difficult to measure (e.g., infections after endoscopy) or when there is difficulty acquiring the data (e.g., contacting the discharged and relocated patient after surgery). Process measures are also helpful in evaluating the effectiveness of an educational effort as a measure of behavior (e.g., compliance with aseptic technique for dressing change) or performance of basic infection prevention procedures, such as hand hygiene. Hepatitis B immunity rates are an example of a process indicator. The other answers are examples of outcome indicators. Reference: APIC Text, 4th edition, Chapter 11 -.Surveillance

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

c. High-level disinfection Rationale: Vaginal probes are used in sonographic scanning. A vaginal probe and all endocavitary probes without a probe cover are semicritical devices because they have direct contact with mucous membranes. It is recommended that a new condom/probe cover should be used to cover the probe for each patient and, because condoms/probe covers may fail, high-level disinfection of the probe should also be performed. These medical devices should be free of all vegetative microorganisms (i.e., mycobacteria, fungi, viruses, bacteria), though small numbers of bacterial spores may be present. Reference: Chapter 31

102. An advantage of a case-control study over a cohort study is that a case-control study: a. Is considered less biased than a cohort study b. Provides stronger evidence for a causal association c. Is less time consuming and less expensive d. Is more valid

c. Is less time consuming and less expensive Rationale: Case-control studies begin with the identification of persons who have the outcome of interest. Then a control group of individuals without the outcome is selected for comparison. Case-control studies are quicker, easier, and cheaper than cohort studies, especially if outcome is rare or has long latency period. Reference: APIC Text, 4th edition, Chapter 20

127. A patient is admitted to the hospital with severe communityacquired pneumonia (CAP). His symptoms include hemoptysis and a multilobar infiltrate seen on chest radiograph. The patient is recovering from a recent influenza virus infection. What organism should be suspected? a. Moraxella catarrhalis b. Streptococcus pneumoniae c. MRSA d. Haemophilus influenza

c. MRSA Rationale: Community-associated MRSA (CA-MRSA) strains are primarily associated with skin and soft tissue infections; however, they are increasingly causing more invasive infections, including severe CAP. CA-MRSA should be suspected in patients with severe CAP plus hemoptysis, multi-lobar or cavitary infiltrate seen on chest radiograph, or neutropenia. Reference: APIC Text, 4th edition, Chapter 36

104. Measures of central tendency are: a. Ratios and rates b. Proportions and standard deviation c. Mean and median d. Percentiles and measures of dispersion

c. Mean and median Rationale: Measures of central tendency describe the values around the middle of a set of data. Two measures of central tendency used in healthcare surveillance are the arithmetic mean and median. The mean is the mathematical average of the values in a set of data. The median is the middle value in a ranked set of data. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance

16. 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 marinurn b. Mycobacterium avium c. Mycobacterium leprae d. Mycobacterium tuberculosis

c. Mycobacterium marinum Rationale: M. marinum causes cutaneous lesions after exposure to swimming pools, fish tanks, or other water sources. The organisms may enter through previously unappreciated superficial nicks and abrasions. The lesions first appear as papules that later ulcerate. Because special culture conditions must be used to isolate the organism, the Microbiology Lab should be alerted if this is a diagnostic consideration. Reference: APIC Text, 4th edition Chapter 95

11. A patient is admitted with measles and placed on Airborne Isolation. How many days after symptom onset would the characteristic blotchy red rash appear? a. On days 1-2 b. On days 7-10 C. On days 3-7 d. On days 21-25

c. On days 3-7 Rationale: Measles symptoms generally appear in two stages. In the first stage, which lasts 2 to 4 days, the individual may have a runny nose, cough, and a slight fever. The eyes may become reddened and sensitive to light, while the fever gradually rises each day, often peaking as high as 103° to 105°F. Koplik spots-(small bluish while spots surrounded by a reddish area) may also appear on the gums and inside of the cheeks. The second stage begins on the third to seventh day and consists of a red blotchy rash lasting 5 to 6 days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities.

117. An IP has been asked to present an educational program to a group of HCP who are culturally different from him. What is the best approach to developing an effective program in this case? a. Develop the program without taking cultural diversity into account, but allow the learners to ask questions while he is teaching b. Be aware of potential cultural differences, but do not incorporate them into the program c. Outline the major points of the educational program, and ask the audience to work together to identify culturally appropriate examples of the major points d. There is no need to take cultural diversity into account because that does not change the learning objectives of the educational program

c. Outline the major points of the educational program, and ask the audience to work together to identify culturally appropriate examples of the major points Rationale: An increasingly diverse workforce has driven ,the need for increased attention to transcultural competence in training programs. Cultural diversity and a mixed workforce are regarded as organizational strengths. People who do not think alike help to create a competitive advantage when problem solving. Concepts of transcultural care need to be incorporated into successful educational activities. Cultural backgrounds will affect the ability of the learner to participate in learning activities and accommodate new skills and ideas. Transcultural education will encompass different perceptions based on geography, gender, religion, social status, age, sexual orientation, and ethnic diversity. Answer C is correct, as this will allow participants to apply the educational content in a manner that is culturally familiar to them. Reference: APIC Text, 4th edition, Chapter 3

135. A dialysis patient who is known to be positive for Hepatitis B has been admitted to the surgical floor for a surgical procedure. The patient will require dialysis three times a week while he is in the hospital. The inpatient dialysis unit does not have an isolation room and is very small. The dialysis nurse has requested the IP's assistance in identifying the best location to dialyze the patient. Which of the following should the IP recommend? a. Transfer the patient to an isolation room in the outpatient unit b. Perform the treatment in the inpatient unit c. Perform the treatment in the patient's hospital room d. Transfer the patient to an isolation room in the ICU

c. Perform the treatment in the patient's hospital room Rationale: While hospitalized, HBsAg-Positive chronic hemodialysis patients should undergo dialysis in a separate room and use separate machines, equipment, instruments, supplies, and medications designed only for HBsAgpositive patients. While HBsAg-positive patients are receiving dialysis, staff members who are caring for them should not care for susceptible patients. References: ,4P/C Text, 4th edition, Chapter 39

53. A patient in Droplet Precautions is scheduled for a procedure in Endoscopy. In addition to following respiratory hygiene and cough etiquette, which of the following is the most appropriate method to reduce the transmission of infectious organisms during transportation of the patient? a. Instruct patient to wear an N95 respirator b. Cover or contain potentially infectious body fluids c. Place a surgical mask on the patient d. Provide respiratory protection for transport personnel

c. Place a surgical mask on the patient Rationale: According to the CbC's 2007 Isolation Guidelines, patient transport outside the room should be limited to medically necessary purposes. If the patient Must leave the room, instruct the patient to wear a surgical mask and follow respiratory hygiene and cough etiquette. Once the patient is masked, the patient transporter,does not need to wear a surgical mask. Notify the receiving department of the Isolation Precautions status. References: APIC Text, 4th edition, Chapter 29

13. 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 virus (EBV) titer <1:8. 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

c. Presumptive identification of HSV infection HSV Type I or 2 IgM antibody for HSV infectoin: <1:10 negative 1:10 or greater is a positive Rationale: The herpesviruses are a family of eight DNA viruses that initiate acute, chronic, and latent infections of the skin, epithelial cells, lymphocytes, and neurons. These include herpes simplex type 1 (HSV-1), herpes simplex type 2 (HSV-2), varicella-zoster virus, EBV, CMV, human herpesvirus 6 (HHV-6), human herpesvirus 7 (HHV-7), and human herpesvirus 8 (HHV-8). Herpesviruses are transmitted by close intimate contact or exposure to virus containing body fluids (saliva, urine, blood, breast milk, and contaminated. respiratory or genital secretions). . Reference: APIC Text, 4th edition, Chapter 80 - Herpes Virus

25. Which of the following scenarios is an example of the preparation phase of the transtheoretical model? a. Auditing reveals that staff compliance with personal protective equipment (PPE) use has increased in the last month b. Data is showing a 96 percent compliance rate for PPE use in the last 10 months c. Staff are discussing strategies to increase PPE use at the monthly staff meeting d. Staff are questioning why they need to wear PPE when caring for patients in isolation

c. Staff are discussing strategies to increase PPE use at the monthly staff meeting Rationale: The principal concept behind the Transtheoretical Model (or Stage Theory) is readiness. For any given health-associated behavior, people will have diverse orientations to change. Some will be unaware that a particular-- change is a desirable option, whereas others will have already completed the change but remain at risk of reversing their progress or relapsing. The stages include Pre-contemplation, Contemplation, Preparation, Action, and Maintenance. The preparation phase is when a person or group of people starts planning for the behavior change. Reference: APIC Text, 4th edition, Chapter 5

14. A patient from a long-term acute care (LTAC) facility is being transferred to an acute care facility for an outpatient procedure. The patient has a history of cryptococcal meningitis. The outpatient department asks the IP what type of Isolation Precautions the patient requires. The IP informs them that the patient requires: a. Airborne Precautions b. Droplet Precautions c. Standard Precautions d. Contact Precautions

c. Standard Precautions Rationale: Cryptococcal meningitis is caused by the fungus Cryptococcus neoformani: This fungus is found in soil around the world. Unlike bacterial meningitis, this form of meningitis comes on more slowly over a few days to a few weeks. Patients with cryptococcal meningitis do not require Isolation Precautions. Standard Precautions should be followed on all patients.

55. This process destroys all forms of microbial life: - a. High-level disinfection b. Cleaning c. Sterilization d. Antisepsis

c. Sterilization Rationale: Sterilization is the term for the process where all microbial life including spores is destroyed: Sterilization may be carried out using steam, hydrogen peroxide gas, ethylene oxide gas, and liquid sterilants. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare - Facilities, 2008, Page 8-9

26. The Director of Facilities informs the IP that water testing of the hospital's hot water tanks and distal sites was positive for Legionella. The IP should consider disinfection of the hospital's water system if: a. There have not had any prior cases of healthcare associated legionellosis b. The IP conducts prospective surveillance of healthcare associated legionellosis and there are no cases c. The colonization rate for distal water sites in the hospital is greater than 30 percent d. The hospital Risk Manager asks for the disinfection to be completed

c. The colonization rate for distal water sites in the hospital is greater than 30 percent Rationale: Legionella pneumophila is a common cause of both community acquired and healthcare-associated pneumonia. Clinical manifestations are nonspecific, but high fever, diarrhea, and hyponatremia are often distinctive. Infection has been linked to drinking water distribution systems of acute care and extended care facilities. Health departments and public agencies have issued infection prevention guidelines aimed at preventing outbreaks. These guidelines include diagnostic testing for Leg/one/la infection and culturing of the drinking water distribution system. Disinfection of the water distribution system includes superheating and flushing with hyper-chlorination as a short term approach to terminating an outbreak. Copper-silver ionization has been validated for long-term systemic disinfection. Chlorine dioxide is a promising alternative disinfection method. Disinfection of the facility's water system should be considered if there is evidence of a prior case(s) of healthcare associated legionellosis, greater than 30 percent colonization of distal sites in the water system, or prospective surveillance for legionellosis detects a healthcare-associated case. Reference: APIC Text, 4th edition, Chapter 84

23. Infection prevention challenges related to body piercings and tattooing include all of the following except: a. There have not been uniform licensure requirements for body art studios b. Reporting of infections to the Public Health Department is limited to bloodborne diseases c. The popularity of tattooing and body piercing has made it more socially acceptable d. Inspectors may not receive adequate training to conduct site inspections

c. The popularity of tattooing and body piercing has made it more socially acceptable Reference: APIC Text, 4th edition, Chapter 123 -

92. The Infection Prevention Manager must apply principles of conflict resolution to resolve growing tension about how best to apply limited department resources in the coming year. For maximum success, the IP manager should use all of the following approaches except: a. Active listening b. Accept responsibility c. Use indirect communication d. Identify points of agreement

c. Use indirect communication Rationale: Conflict resolution refers to the methods and processes involved in facilitating the peaceful ending of conflict and preventing retribution. A wide range of methods and procedures for addressing conflict exist and include negotiation,mediation, diplomacy, and creative peace building. Reference: APIC Text, 4th edition, Chapter 3

80. Which of the following is an example of syndromic surveillance? 1) Analyzing Emergency Department records for reports of influenza-like illness (ILI) 2) Monitoring sentinel chickens in the community for antibodies to arboviruses 3) Tracking all laboratory orders for respiratory cultures 4) Monitoring over-the-counter drug sales for cough medicine a. 2, 3, 4 b. 1, 2, 4 c. 1, 2, 3 d. 1, 3, 4

d. 1, 3, 4 It is not monitoring sentinel chickens in the community for antibodies to arboviruses. The monitoring of chickens for antibodies to arboviruses is an example of sentinel surveillance, which is an alternative to 'population-based surveillance and involves collecting data from a sample of reporting sites (sentinel sites). Rationale: Syndromic surveillance is used for early detection of outbreaks; to follow the size, spread, and tempo of outbreaks; to monitor disease trends; and to provide reassurance that an outbreak has not occurred. Syndromic surveillance systems use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks. The fundamental objective of syndromic surveillance is to identify illness clusters early, before diagnoses are confirmed and reported to public health agencies, and to mobilize a rapid response, thereby reducing morbidity and mortality. Answers 1, 3, and 4 are all examples of Syndromic surveillance. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance

1. The infection preventionist (IP) on the Antimicrobial Stewardship Team is thinking of ways that he can support efforts and add to the success of the team in decreasing antimicrobial resistance. Some of the activities that he can do to help with the mission of the team include: '1) Calculate multidrug-resistant organism (MDRO) infection rates 2) Detect asymptomatic carriers using active surveillance cultures 3) Use molecular typing for investigating outbreaks 4) Collect environmental cultures of isolation rooms a. 2, 3, 4 b. 1, 3, 4 c. 1, 2, 4 d. 1, 2, 3

d. 1,2,3 1) Calculate multidrug-resistant organism (MDRO) infection rates 2) Detect asymptomatic carriers using active surveillance cultures 3) Use molecular typing for investigating outbreaks Rationale: Surveillance of MDROs is critical to an antimicrobial stewardship program. IPs monitoring microbiology isolates to detect prevalence and emergence of MDROs. IPs may also support antimicrobial stewardship efforts in the following ways: • Calculate MDRO incidence on the basis of clinical culture results • Calculate MDRO infection rates • Use molecular typing for investigating outbreaks • Detect asymptomatic carriers using active surveillance cultures References: APIC Text, 4th edition, Chapter 26

21. Which of the following is an example of infectious waste? a. An unused syringe and needle that were discarded after accidentally being dropped on the floor b. A gauze pad with a small amount of blood on it c. Gloves that were worn to administer a Hepatitis B vaccine d. Agar plates used for testing sputum samples in the microbiology lab

d. Agar plates used for testing sputum samples in the microbiology lab Rationale: Any objects with the potential to have sufficient dose of a pathogen, a portal of entry, and a method of being transmitted are considered to be infectious waste. Bacterial cultures that have amplified potential pathogens may also have sharp edges and should be considered infectious waste. Non-penetrating objects with minimal blood and body fluid contamination are not infectious waste. Unused sharps are not infectious waste but must be disposed of in a sharps container because of the high risk of puncture injuries and inability to know that the object was not contaminated. Reference: APIC Text, 4th edition, Chapter 113

70. The existence of an outbreak is most often determined by: a. The identification of more than 10 new cases per week b. An incidence rate that is more than two standard deviations higher than the previous year c. Detection of a cluster of organisms within more than one population. d. An incidence of disease that is clearly in excess of that expected

d. An incidence of disease that is clearly- in excess of that expected Rationale: Outbreaks in healthcare should be suspected when HAls or adverse events occur above the background rate or when an unusual microbe or advere event is recognized. Healthcare-associated outbreaks often have multiple causes, but almost all are due to one or more of the following: lapses in infection prevention or clinical practices, colonization or infection of HCP, or defects in or contamination of a product or device, either at the tire of production (intrinsic contamination) or during use (extrinsic contamination). Outbreaks in healthcare settings may also be caused by visitors who have, or are harboring, an infectious disease (e.g., influenza or chickenpox). Reference: APIC Text, 4th editiop, Chapter 11

8. 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)

d. An outbreak of ventilator-associated Acinetobacter infections in the Intensive Care Unit (ICU) Rationale: Detection and identification of certain HAls may suggest HVAC malfunction (e.g., healthcare-associated tuberculosis, single case of aspergillosis in a severely immunosuppressed patient, healthcare-associated varicella infections). Analysis of postoperative SSI rates and associated infectious agents may offer important clues to problems in the OR air system(s). HVAC systems are usually not the immediate cause of device associated HAls. Reference: APIC Text, 4th edition, Chapter 114 - Heating, Ventilation, and Air Conditioning

54. A pregnant environmental services worker, who is nonimmune to varicella, enters the room of a patient with confirmed varicella (chickenpox) before an isolation sign is posted. She spends 6 minutes in the room with the patient (who is not wearing a mask). This exposure happened on January 11. After giving the employee varicella-zoster immune globulin (VZIG), it is determined that that she should be excluded from work. What day can she return to work? a. January 31 b. February 1 c. February 8 d. February 9

d. February 9 Rationale: The healthcare worker was given VZIG. Normal time off would be from day 10 through day 21 after exposure, but because VZIG was given, it is recommended to keep the employee off through day 28 (able to return on the 29th day after the exposure). References: APIC Text, 4th edition,•Chapter 100

18 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 bioterrorism disaster drill d. Funding a program that will provide ring vaccination of exposed people against smallpox during an outbreak

d. Funding a program that will provide ring vaccination of exposed people against smallpox during an outbreak Rationale: Disasters should be planned for and responded to using the principles of emergency management. Emergency management is composed of four principles: mitigation, preparedness, response, and recovery. Mitigation describes actions taken to decrease the potential impact of a situation. These include interventions to either prevent or reduce morbidity and mortality and ease the economic and social impact of the event on the affected community. Funding a program that will provide ring vaccination of exposed people against smallpox during an outbreak is an example of mitigation because the activity will help prevent further morbidity and mortality. Reference: APIC Text, 4th edition, Chapter 119

62. This type of sterilizer works by forcing steam into the chamber from the top and pushing the air in the chamber out the bottom f the chamber: a. Steam sterilizer b. Ethylene oxide sterilizer c. Dynamic air removal steam sterilizer d. Gravity displacement steam sterilizer

d. Gravity displacement steam sterilizer Rationale: A gravity displacement sterilizer works by admitting steam into the sterilizer chamber. The steam has lower density than the air in the chamber, so the steam initially stays at the top of the chamber and then pushes the air out of a drain vent in the bottom of the chamber. Chapter 106

21. 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

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 Rationale: The root cause analysis (RCA) process takes a retrospective look at adverse outcomes and determines what happened, why it happened, and what an organization can do to prevent the situation from recurring. Risk managers commonly use the RCA to investigate major incidents, sentinel events, or errors in healthcare delivery. The RCA process avoids individual blame, considers human factors engineering, and analyzes redesign for a safer system. When conducting RCA, a multidisciplinary team discovers basic and contributing causes for what happened. The team includes frontline staff, and individuals most familiar with the situation to dig deep into the process, asking why something happens at each level of cause and effect. The entire RCA process identifies changes to a particular process or system that improves safety or reduces process error. A thorough RCA determines: (1) human and other factors; (2) the process or system involved; (3) underlying causes and effects of the process; and (4) the risks and potential contributions to failure or adverse results. Reference: APIC Text, 4th edition, Chapter 16

133. Which of the following is used to determine efficacy of antimicrobials on a particular pathogen? a. KOH preparation b. Methylene blue stain c. Rapid Plasma Reagin d. Kirby-Bauer test

d. Kirby-Bauer test Rationale: Kirby-Bauer antibiotic testing-(KB testing or disc diffusion antibiotic sensitivity testing) is a method to determine the sensitivity of microorganisms to specific antimicrobial drugs; greater drug efficacy yields larger microbe-free zones surrounding drug-containing disks after overnight growth on solid media. Reference: APIC Text, 4th edition, Chapter 25

20. 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

d. Mycoplasma pneumoniae Rationale: 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.

132. Which of the following is not an example of syndromic surveillance? a. Number of patients seen in the Emergency Room with influenza-like illness b. Number of purchases of over-the-county flu remedy medications c. Number of school absences related to illness d. Number of new cancer diagnoses reported to the cancer registry

d. Number of new cancer diagnoses reported to the cancer registry Rationale: Syndromic surveillance now includes any indicator that might signal an increase in illness in the community. Some examples of data that could be collected and analyzed as part of a syndromic surveillance program include (1) number of patients seen in an emergency department; (2) number of patients presenting to the emergency department with influenza-like illness as their chief symptom; (3) number of patients admitted to a hospital; (4) number of emergency medical services or ambulance runs performed each day, week, month, or other time period; (5) number of purchases of over-the counter flu remedies; (6) number of purchases of over-the-counter diarrhea medications; or (7) other data available from healthcare facilities or agencies that may indicate a change or trend in the community. Reference: APIC Text, 4th edition, Chapter 117

71. Decontamination is the process by which an item is: a. Cleaned of all soil and germs b. Rendered free from all pathogens and infectious organisms c. Sterilized and ready for reuse d. Rendered safe for handling without protective attire

d. Rendered safe for handling without protective attire Rationale: Decontamination renders an area,' device, item; or material safe to handle (i.e., safe in the context of being reasonably free from a risk of disease transmission). The primary objective is to reduce the level of microbial contamination so that infection transmission is eliminated. Reference: APIC Text, 4th edition, Chapter 31

7. 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 epidemiologic 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 epidemiologic investigation is being conducted

d. Routine environmental culturing should not be considered unless an epidemiologic investigation is being conducted Rationale: Microbiological environmental testing is not generally recommended. Environmental culturing can be costly and may require special laboratory procedures. Additionally, in most cases no standards for comparison exist. Because of the lack of standards, environmental testing may generate inconclusive data that could result in the implementation of unnecessary procedures or treatment. Rationale for special environmental monitoring should be carefully planned and limited to epidemiological investigations. In limited situations, "routine" environmental sampling may be indicated. Reference: APIC Text, 4th edition, Chapter 24 - Microbiology Basics

60. A patient with MRSA infection has been admitted and is in need of physical therapy. The physical therapist would like the patient to ambulate in the hall. The IP should recommend: a. The patient should not ambulate in the hall b. The patient may ambulate but only outside of the hospital c. The patient may ambulate in the hallway if attendants wear appropriate PPE d. The patient may ambulate in the hallway if he washes his hands and wears a clean gown

d. The patient may ambulate in the hallway if he washes his . hands and wears a clean gown Rationale: Transmission of MOROs such as MRSA is an issue of great concern for al l types of healthcare facilities. Barrier protection should be used to contain wound drainage, urine, feces, and other excretions or secretions whenever possible to allow for patient independence and participation in therapeutic sessions. If the patient has an acute contagious disease or illness, or if excretions or secretions cannot be contained, appropriate Isolation Precautions (Transmission-based Precautions) should be used. If the patient on Transmission-based Precautions needs to leave the room for any reason, it is important that: • Appropriate barriers are worn or used by the patient (i.e., masks, dressings that contain drainage) • All team members, including the patient and family/significant other(s), are aware of the precautions needed • Patients are informed of ways they can help in preventing- the transmission of MDRO to others (i.e., hand washing with soap and water or alcohol based hand rub before leaving the room and clean clothing) Reference: APIC Text, 4th edition, Chapter 66 -

115. An adult patient is, admitted through the Emergency Department with a 1-day history of rash, fever, and cough. The attending physician is concerned that the patient has measles, as the patient cannot recall whether he has had measles disease or vaccine in the past. The serum sample does not contain measles-specific IgG or IgM antibodies. What is the significance of this finding? a. The patient does not have measles infection b. The patient has had the measles vaccine in the past c. The patient has a history of measles disease d. The patient might be infected with measles

d. The patient might be infected with measles Rationale: If the patient had been vaccinated or had a history of measles disease, his serum sample would most likely have contained measles-specific IgG antibody. We cannot assume that the patient does not have measles infection at only 24 hours after the onset of rash, as there might not have been enough time yet for the immune response to develop. It can take up to 72 hours after the onset of rash for IgM.tb be produced in response to measles infection, so this patient might be infected. Reference: APIC Text, 4th edition, Chapter 86 -

103. Which of the following statements is accurate about adult learners? a. They do not readily speak out if their learning needs are not being met b. They have a preference for academic knowledge rather than practical knowledge c. Most older adults have the same technological capabilities as younger adults d. They are more likely to transfer knowledge to practice if education sessions are interactive

d. They are more likely to transfer knowledge to practice if education sessions are interactive Rationale: Research shows, that adult learners retain and use more of the knowledge they gain if they are encouraged to apply what they learned. . Reference: APIC Text, 4th edition, Chapter 3

94. A patient in your facility has been diagnosed with naturally acquired inhalational Anthrax, and Environmental Services need to know how to terminally clean the patient's room. Which protocol should they follow? a. They should clean the room with a protocol similar to the one used for patients with C. difficile b. They should only use an EPA-registered disinfectant with proven effectiveness against Anthrax c. The should call the Centers for Disease Control and Prevention to come clean the room d. They should use the standard terminal cleaning protocol

d. They should use the standard terminal cleaning protocol Rationale: Anthrax is an illness caused by Bacillus anthracis, a spore-forming bacterium. Infection with Bacillus anthracis can be acquired through exposure to contaminated soil, water, oil animals, including imported animal skin drums. It can also be acquired as a consequence of a bioterrorism event, where the spore form of the agent might be released into the environment. In the case of a naturally-acquired case of anthrax, there is no person-to-person transmission of the agent and no environmental contamination of the patient room with the spores. Therefore, no special cleanihg protocol is needed in this case. However, a bioterrorism event with release of spores in the facility would warrant higher level decontamination and would warrant higher level decontamination and cleaning.

14. A patient is suspected of having Pertussis. A nasopharyngeal aspirate is collected for direct fluorescent antibody (DFA) testing and for culture eight hours after antimicrobial therapy is started. The DFA test is negative but the culture test is positive. Does this patient have Pertussis? a. No, because the DFA test is highly specific and it was negative b. No, because culture of Bordatella pertussis has very low sensitivity c. No, because all testing is unreliable if antimicrobial therapy has been initiated prior to specimen collection d. Yes, because the culture test is 100 percent specific for identification of Bordatella pertussis

d. Yes, because the culture test is 100 percent specific for identification of Bordatella pertussis Rationale: Pertussis is caused by the bacterium Bordatella pertussis. Diagnosis may occur by culture, DFA, or polymerase chain reaction testing. Culture of B. pertussis is carried out on Bordet-Gengout or Regan-Lowe media with nasopharyngeal samples and has varying sensitivity depending on specimen handling and whether antimicrobial therapy was initiated prior to specimen collection. DFA testing is very specific but not very sensitive, and PCR testing has good sensitivity and variable specificity. A negative DFA test may not mean that a patient doesn't actually have pertussis because this-test has low sensitivity and thus there is a chance of false negative tests, so a culture test must be performed to confirm DFA test results. If the culture test is negative then this cannot rule out pertussis because culture may have low sensitivity, but- if a culture test- is positive then the patient has pertussis because the 100 percent specificity of the test means that there are no false positive results., References: APIC Text, 54th edition, Chapter 71 Bordetella pertussis;

Any objects with the potential to have sufficient dose of a pathogen, a portal of entry, and a method of being transmitted are considered to be infectious waste. Bacterial cultures that have amplified potential pathogens may also have sharp edges and should be considered _______________________________________ __________________________________.

infectious waste

The incubation period for pneumonic plague is?

l to 6 days, but most commonly occurs 2 to 4 days after exposure.

83. Which of the following recommendations related to disinfection and sterilization in healthcare facilities is a CDC category 1A recommendation? 1) "Before use on each patient, sterilize critical medical and surgical devices and instruments that enter normally sterile tissue or the vascular system or through which a sterile body fluid flows" 2) "Meticulously clean patient-care items with water and detergent, or with water and enzymatic cleaners before high-level disinfection or sterilization procedures." 3) "In hospitals, perform most cleaning, disinfection, and sterilization of patient-care devices in a central processing department in order to more easily control quality." 4) "Perform low-level disinfection for noncritical patient-care surfaces (e.g., bedrails, over-the-bed table) and equipment (e.g., blood pressure cuff) that touch intact skin" a. 1 b. 1,3 c. 1, 2, 4 d. 1, 2, 3, 4

"Before use on each patient, sterilize critical medical and surgical devices and instruments that enter normally sterile tissue or the vascular system or through which a sterile body fluid flows" Rationale: The CDC has established a system for cataloging recommendations based on the amount of data available to support the recommendation. Category 'IA recommendations are strongly supported by epidemiologic, clinical, or experimental data from well-designed studies. Sterilization of medical instruments that will come into contact with sterile tissue or the vascular system is a Category "lA recommendation. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Page 83-84

The probability of infection is determined by the interaction of four clinical variables:

(1) inoculum of bacteria, (2) virulence of bacteria, (3) adjuvants in the micro-environnnent, and (4) efficiency of host defenses.

17. What is the probability of committing a Type I error if the p value is 0.10? a. 1 in 10 b. 1 in 100 c. 1 in 5 d. 1 in 20

1 in 10 Rationale: A Type I error occurs when one rejects the null hypothesis (Ho) - when it is true. This is also called a false-positive result (we incorrectly conclude that the research hypothesis is true when in fact it is not). The p value or calculated probability, is the estimated probability of rejecting the null hypothesis of a study question when that hypothesis is true. A p value of 0.10 indicates a 10 percent (or 1 in 10) chance of making a Type 1 error. Reference: APIC Text, 4th edition, Chapter 13

8. Frequency histograms and polygons are most useful for variables of what level of measurement? 1) Interval scale 2) Ratio scale 3) Nominal scale 4) Ordinal scale a. 1,2 b. 1,3 c. 2,3 d. 3,4

1) Interval scale 2) Ratio scale Rationale: A histogram is a graphic of a frequency distribution in which one bar is used for each time interval, and there is no space between the intervals (see Figure PE3-1). It is used to portray the (grouped) frequency distribution of a variable at the interval or ratio level of measurement. A frequency polygon (see Figure PE3-2) is similar to a line graph, but each coordinate point is represented by a point displayed on the graph with straight lines connecting them. A frequency polygon will provide the same data information as a histogram

131. Which of the following studies is experimental rather than observational? a. Cohort b. Clinical trial C. Case-control d. Cross-sectional

Clinical trial Rationale: Experimental studies are prospective studies designed to compare outcomes in individuals who are assigned to an experimental (intervention) or control (placebo or standard care) group. The intervention may be a procedure, drug, or other treatment, and the comparison group usually receives a placebo, the previously accepted treatment, or, if appropriate, no treatment. The two major types of experimental studies are randomized clinical and community trials. Reference: APIC Text, 4th edition, Chapter 20

13. The IP has worked with the Preoperative Services manager to plan and implement practices to help decrease the bioburden of microorganisms on patients' skin prior to planned surgeries. Which of the following might be included in their plan? 1) Active surveillance culturing for epidemiologically significant organisms 2) Preoperative showering using antimicrobial soap 3) Preoperative antibiotics given prior to the "cut time" 4) Treatment of remote site infections prior to surgery a. 1, 2, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 3, 4

1) Active surveillance culturing for epidemiologically significant organisms 2) Preoperative showering using antimicrobial soap 4) Treatment of remote site infections prior to surgery Rationale: Prevention strategies to reduce SSIs include: • Administer antimicrobial prophylaxis in accordance with evidence-based standards and guidelines (within 1 hour prior to incision, 2 hours for vancomycin and fluoroquinolones). • Identify and treat remote infections before elective operation. Preoperative antibiotics are not given to reduce the microorganism bioburden prior to surgery. The following are examples of activities that may reduce the bioload of microorganisms on patients' skin: • Washing from clean to less-clean areas using clean washcloths to prevent cross contamination • Preoperative showering using antimicrobial soap • Washing with antimicrobial soaps, such as chlorhexidine gluconate, to reduce carriage of resistant organisms, such as MRSA • Active surveillance culturing for epidemiologically significant organisms based on the facility's epidemiology • Encouraging or assisting patients in maintaining good oral hygiene and caring for the mouth to reduce the risk of mucositis in immunosuppressed persons • Encouraging good genital-area cleansing • Good hand hygiene practices using soap and water or alcohol-based hand rubs, as appropriate • Treatment of remote site infections prior to surgery • Additional personal risk-reduction strategies, include smoking cessation or weight loss if possible and appropriate Reference: APIC Text, 4th edition, Chapter 21 - Risk Factors Facilitating Transmission of Infectious

27. Which of the following recommendations related to disinfection and sterilization in healthcare facilities is a CDC category 1A recommendation? 1) Before use on each patient, sterilize critical medical and surgical devices and instruments that enter normally sterile tissue or the vascular system or through which a sterile body fluid flows 2) Meticulously clean patient-care items with water and detergent, or with water and enzymatic cleaners before high-level disinfection or sterilization procedures. 3) In hospitals, perform most cleaning, disinfection, and sterilization of patient-care devices in a central processing department in order to more easily control quality. 4) Perform low-level disinfection for noncritical patient-care surfaces (e.g., bedrails, over-the-bed table) and equipment (e.g., blood pressure cuff) that touch intact skin a. 1 b. 1,3 c. 1, 2, 4 d. 1, 2, 3, 4

1) Before use on each patient, sterilize critical medical and surgical devices and instruments that enter normally sterile tissue or the vascular system or through which a sterile body fluid flows Rationale: The CDC has established a system for cataloging recommendations based on the amount of data available to support the recommendation: Category 1A recommendations are strongly, supported by epidemiologic, clinical data, or experimental data from well-designed studies. Sterilization of medical instruments that will come into contact with sterile tissue or the vascular system is a Category 1A recommendation._ Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Page: 83-84

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

1,3 Rationale: 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. The venipuncture site should be cleaned with an antiseptic first to minimize the risk of contaminating the blood specimen with common commensals. It is critical that blood cultUres be drawn prior to initiation of antibiotic therapy. Blood may not be sterile immediately following antimicrobial therapy. If empiric antibiotic therapy is initiated on an emergency basis, cultures should be obtained as soon as possible following the first dose. The volume of blood obtained for culture is a critical variable in detecting bacteremia or fungemia. Specimen collection from a central venous catheter is not recommended due to the risk of intraluminal bacterial contamination of the device. Percutaneous venipuncture from two separate sites is preferred. References: APIC Text, 4th edition, Chapter 24

76. Epidemic kerato-conjunctivitis (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 percent hydrogen peroxide 2) Sterilize ophthalmoscopes 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

1,3,4 Rationale: Prevention of EKC requires meticulous attention to hand washing. Soap and water and/or an alcohol-based hand sanitizer should be used before and after each patient contact. Gloves should be worn and discarded appropriately during outbreaks and when exposure to patient's tears or excretions is likely. The current CDC recommendations for disinfection of tonometer tips include a 5 to 10 minute soak in 3 percent hydrogen peroxide, 70 percent isopropyl, 70 percent ethyl alcohol, or in 5,000 ppm bleach. Ophthalmoscopes should be wiped with 70 percent alcohol between patients. Reference: APIC Text, 4th edition, Chapter 63

IPs may also support antimicrobial stewardship efforts in the following ways:

1. Calculate MDRO incidence on the basis of clinical culture results 2. Calculate MDRO infection rates 3. Use molecular typing for investigating outbreaks 4. Detect asymptomatic carriers using active surveillance cultures

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 Rationale: The incubation period for meningococcal meningitis is between 2 to 10 days, commonly 3 to 4 days.

50. A robust Performance Improvement team should perform all of the following except: a. Observational audits b. Benchmark comparisons c. Root cause analyses d. Housewide infection rates

50. Housewide infection rates Rationale: 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 benchmarking the organization's infection rate against community, state, and national averages.. Chapter 16

49. The safe temperature range for cold food storage is: a. 41°F/5°C or lower b. 42°F to 50°F/5.6°C to 10°C c. 50°F to 55°F/10°C to 12.8°C d. Less than 60°F/15.6°C

49. 41°F/5°C or lower Rationale: Cold foods for serving must be held at 41°F/5°C:or lower. The temperature danger zone is 41°F to 135°F/5°C to 57°C, which is the temperature range for rapid multiplication of virtually all bacteria associated with foodborne disease. Chapter 109 - Nutrition

67. A pregnant healthcare worker 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 worker 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 Rationale: CHV 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.N No vaccine is available for CMV and consistent adherence to Standard Precautions is the only preventive measure. References: APIC Text, 4th edition Chapter 104 - Pregnant

Can a tunneled cuffed catheters be used on the same side as a maturing AV access?

In addition, tunneled cuffed catheters should NOT be placed on the same side as a maturing AV access if possible. Femoral catheters should be placed only in bed-bound patients only with good exit site care and should be left in place for no more than 5 days because of associated infection rates.

Can terrorist use pneumonic plague?

It is possible that the terrorists will genetically alter the strain of plague they release and make it antibiotic resistant. If an antibiotic-resistant strain is used in a bioterrorism attack and isolation is discontinued after 48 hours, the patient would remain infectious and thus constitute a risk to staff, patients, and visitors. Isolation should not be discontinued until 48 hours of appropriate therapy and when the patient is showing signs of clinical improvement.

108. When transporting used instruments from the operating room to the decontamination area, they must be transported in: a. An open bin b. Large plastic bags c. Puncture-proof, sealable containers labeled as biohazardous d. A bin draped with a sheet

Puncture-proof, sealable containers labeled as biohazardous Rationale: Contaminated items should be placed in puncture-proof, sealable containers and visibly labeled biohazardous. The selection of the container will depend on the size, presence of sharps, configuration, and volume/ numbers of medical devices or instruments being transported. Reference: APIC Text, 4th edition, Chapter 106 - Sterile

53. Which of the following describes aerobic bacteria? a. Do not require oxygen to grow and are harmed by its presence b. Require oxygen to grow and survive c. Can grow with or without oxygen d. Do not require oxygen for growth but tolerate the presence of it

Require oxygen to grow and survive Rationale: Oxygen is a universal component of cells. Prokaryotes display a wide range of responses to oxygen. Aerobic bacteria require oxygen to grow and survive.

79. An IP has completed the investigation of an increase in postdischarge SS's 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 Rationale: Surveillance activities should support a system that can identify risk factors for infection and other adverse advents, implement risk-reduction measures, and monitor the effectiveness of interventionli The items noted in answers A, B, and D are rarely related to the development of SSIs. The facility's surveillance program should be, revised to reflect the current risks and risk reduction measures. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance

7. How can streptococci be differentiated from staphylococci under the microscope following the Gram stain procedure? a. Staphylococci are Gram posit ive cocci, while streptococci are Gram positive bacilli b. Staphylococci are Gram negative bacilli, while streptococci are Gram negative cocci c. Staphylococci are Gram positive, while streptococci are Gram negative d. Staphylococci are Gram positive and grow in grape-like clusters, while streptococci which are also Gram positive, grow in chains

Staphylococci are Gram positive and grow in grape-like clusters, while streptococci, which are also Gram positive, grow in chains Rationale: Both staphylococci and streptococci have round, spherical cell shapes, but the arrangement of cells is different due to a different binary fission. Streptococci form a chain of round cells, because their division occurs in one linear direction, while staphylococci divide in various directions forming grape-like clusters. Both are facultatively anaerobic gram-positive bacteria. Reference: APIC Text, 4th edition, Chapter 9

What access for hemodialysis should be used for long-term?

The CDC recommend an AV fistula be created and used for long-term hemodialysis treatment because of the lower incidence of infection and set a fistula creation target of 65 percent by 2009. If an AV fistula cannot be established, an AV graft is the next preferred type of access. Because of infection risk, creation of the fistula in the upper arm is preferred over the thigh. For acute hemodialysis, where access for less than 3 weeks' duration is anticipated, vascular access may be obtained using a noncuffed or cuffed catheter. However, if a catheter must be used for access for longer than 3 weeks, a tunneled, cuffed venous catheter is recommended.

126. There is a shortage of influenza vaccine, and the IP has been asked to help prioritize the administration of the vaccine among HCP in the facility. Which of the following employee groups would be among the highest priority for immunization? a. The admissions clerk in the ED b. The Lung Transplant Coordinator c. A nurse in labor and delivery d. The CEO of the hospital

The Lung Transplant Coordinator Rationale: Of all HCP listed, this employee would get priority because they work postoperatively with immunocompromised patients who are at high risk for influenza infection. Any HCP who work with high-risk patients should be vaccinated against influenza. Reference: APIC Text, 4th edition, Chapter 103

6. Phlebotomists within an organization are complaining that the new blood collection device introduced 6 months ago is difficult to use for blood draws and has resulted in an increase in needlestick injuries. The IP is working with Occupational Health to evaluate the problem and would like to compare NSI rates before and after implementation of the device. Which of the following would be the most useful denominator in order to calculate useful data? a. Phlebotomist employee hours at work (full-time equivalents) b. Number of occupied beds (or licensed beds) c. Number of patients (average daily census) d. Number of blood collection devices used or purchased

The answer is the Number of blood collection devices used or purchased Rationale: The denominator should represent the potential for exposure to sharps. There are many possible denominators that may be used, and each will provide a different view of the sharps injury situation in the facility. A device based rate can be used to compare needlestick risk from different devices and to evaluate the effectiveness of the product design. Because blood draws may be performed by nurses, phlebotomists, or physicians, total device-associated needle stick injuries since implementation of the new product will provide the most, useful data. Chapter 100

What is the primary purpose of epidemiology

The primary purpose of epidemiology is to aid in the understanding of the cause of a disease by knowing its distribution; determinants in terms of person, place, and time; and natural history.

Principles of conflict resolution include:

Use direct communication Listen actively Think before reacting Attack the problem, don't make it personal Accept responsibility ° Look for common interests Focus on the future

72. The IP has identified an increased incidence of catheter-related bloodstream infections in the NICU. The IP is preparing her report for presentation to the Infection Prevention Committee. Among the following actions listed, which should be included in the IP's report as the next step? a. Changing the type of catheter used b. Using a multidisciplinary approach to determine corrective actions c. Revising the NICU admission policy d. Revising the NICU staffing plan

Using a multidisciplinary approach to determine corrective actions Rationale: Answers A, C, and D may be actions recommended following thorough review and discussion of the surveillance data, but they are not the next steps to take without first seeking input on the appropriate corrective actions from the appropriate stakeholders. Reference: APIC Text, 4th edition, Chapter 11 - Surveillance

59. During rounds in several patient care areas, the IP discovers several cardboard boxes being used to store patient care supplies. She informs the unit manager that another method of storing supplies must be implemented because: a. The boxes cause clutter in the storeroom b. Cardboard can only be used to store supplies in soiled utility rooms c. The boxes may harbor dust, bacteria, and insects d. The boxes are a fire hazard

c. boxes may harbor dust, bacteria, and insects Rationale: Corrugated cardboard boxes are not appropriate as storage units in medical or clean supply rooms because the boxes may harbor dust, bacteria, and small insects-that have entered during shipping.

28. Which of the following is an advantage of orthophthalaldehyde (OPA) over glutaraldehyde? a. OPA does not require activation b. OPA is compatible with many more materials than glutaraldehyde c. It does not stain skin d. No personal protective equipment is needed to handle OPA

a. OPA does not require activation Rationale: There are several advantages of OPA over glutaraldehyde. OPA requires no activation, is stable over a range of pH values, does not irritate the eyes and nose, and does not have a strong odor. Both OPA and glutaraldehyde are compatible with many types of materials. Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Page 48-49

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

i,3 Rationale: 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.

HICPAC Categorization Scheme for Recommendations Category IA

strong recommendation supported by high to moderate quality evidence suggesting net clinical benefits or harms.