Practice Exam 2

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

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.

HICPAC Categorization Scheme for Recommendations Category 1C

A strong recommendation required by state or federal regulation

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.

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])

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

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

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.

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.

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.

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

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.

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.

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.

What is the bacteria that cause plague?

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

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

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

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

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.

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.

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

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

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

The incubation period for pneumonic plague is?

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

HICPAC Categorization Scheme for Recommendations Category IA

strong recommendation supported by high to moderate quality evidence suggesting net clinical benefits or harms.

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.

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

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.

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)

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.

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

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.

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.

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

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.

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).

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.

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.

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. Reference: Chapter 100

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.

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.

What are the symptoms of Typhus?

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

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

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

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

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

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. Reference: APIC Text, 4th edition, Chapter 13 - Use of Statistics

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.

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

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.

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

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

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.

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.

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

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

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.

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

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 -

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 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 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 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. 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

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

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.

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

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

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

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

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 -

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.

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

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

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 -

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.

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 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

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

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

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