CBIC CIC - CBIC Certified Infection Control Exam

The correct answer is C, "Ambulance personnel should be evaluated for possible exposure," as this statement is true regarding the need for evaluating exposure to communicable illness. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, the presence of Gram negative diplococci in a cerebral spinal fluid (CSF) specimen is suggestive of a serious bacterial infection, most likely Neisseria meningitidis, which causes meningococcal disease. This condition is highly contagious and can be transmitted through respiratory droplets or direct contact with respiratory secretions, particularly during procedures like intubation (CBIC Practice Analysis, 2022, Domain I: Identification of Infectious Disease Processes, Competency 1.1 - Identify infectious disease processes). The patient was intubated during ambulance transport, creating a potential aerosol-generating procedure (AGP) that could have exposed ambulance personnel to infectious droplets before Droplet Precautions were instituted upon arrival at the Emergency Department (ED). Therefore, evaluating ambulance personnel for possible exposure is necessary to assess their risk and determine if post-exposure prophylaxis (e.g., antibiotics) or monitoring is required.

Option A (follow-up evaluation is not required for this laboratory finding) is incorrect because the identification of Gram negative diplococci in CSF is a critical finding that warrants investigation due to the potential for meningococcal disease, a reportable and transmissible condition. Option B (ED personnel should be evaluated for possible exposure) is less applicable since the patient was immediately placed in Droplet Precautions upon ED admission, minimizing exposure risk to ED staff after that point, though it could be considered if exposure occurred before precautions were fully implemented. Option D (follow-up evaluation is not necessary as the appropriate precautions were promptly instituted) is inaccurate because the prompt institution of Droplet Precautions in the ED does not retroactively address the exposure risk during ambulance transport, where precautions were not in place.

The focus on evaluating ambulance personnel aligns with CBIC’s emphasis on identifying and mitigating transmission risks associated with communicable diseases, particularly in high-risk settings like ambulance transport (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents). This step is supported by CDC guidelines, which recommend exposure evaluation and prophylaxis for close contacts of meningococcal disease cases (CDC Meningococcal Disease Management, 2021).

The Chi-square test is the most appropriate test for comparing infection rates (categorical data) before and after an intervention​.

CBIC Infection Control References:

CIC Study Guide, "Statistical Analysis in Infection Control," Chapter 5​.

Antimicrobial stewardship is the most effective strategy to reduce C. difficile infections (CDI) by limiting the use of broad-spectrum antibiotics​.

Quaternary ammonium disinfectants (A) are ineffective against C. difficile spores; bleach-based disinfectants are preferred.

Routine screening (C) is not cost-effective for prevention.

Alcohol-based hand rubs (D) do not kill C. difficile spores; soap and water should be used.

CBIC Infection Control References:

APIC Text, "C. difficile Prevention Strategies," Chapter 9​.

ThePlan, Do, Study, Act (PDSA) modelis awidely used performance improvement tool in infection prevention. It focuses oncontinuous quality improvementthroughplanning, implementing, analyzing data, and making adjustments. This model aligns withinfection control program evaluationsandThe Joint Commission’s infection prevention and control standards.

Why the Other Options Are Incorrect?

A. Six Sigma– Adata-driven process improvement methodbut not as commonly used in infection control as PDSA.

B. Failure Mode and Effects Analysis (FMEA)– Used toidentify risks before implementation, rather than ongoing evaluation.

D. Root Cause Analysis (RCA)– Used toanalyze failures after they occur, rather than guiding continuous improvement.

CBIC Infection Control Reference

ThePDSA cycle is a recognized model for evaluating and improving infection control plans​.

Thebest strategy to reduce the risk of infectionin hemodialysis patients is to use anarteriovenous (AV) fistulaas the preferred vascular access method.AV fistulas have the lowest infection rates compared to catheters and graftsbecause they do not involve foreign material and are less prone to biofilm formation and bloodstream infections.

Why the Other Options Are Incorrect?

B. Use of a non-cuffed percutaneous catheter– Non-cuffed catheters have ahigher risk of bloodstream infectionsand should be used only for short-term access.

C. Placement of a femoral catheter–Femoral catheters have higher infection risksand should only be usedfor bed-bound patients and for the shortest duration possible.

D. Replacement of dialysis catheters monthly–Routine catheter replacement does not reduce infection riskand should be done only when medically necessary.

CBIC Infection Control Reference

According toAPIC guidelines, AV fistulas arethe preferred vascular accessdue to theirlower infection rates and improved long-term outcomes​.

When an infection preventionist (IP) identifies an increase in primary bloodstream infections (BSIs) associated with peripheral intravenous (IV) catheter insertion, the initial step in outbreak investigation and process improvement is to stratify the data to identify potential sources or patterns of infection. According to the Certification Board of Infection Control and Epidemiology (CBIC), the "Surveillance and Epidemiologic Investigation" domain emphasizes the importance of systematically analyzing data to pinpoint contributing factors, such as location, technique, or equipment use, in healthcare-associated infections (HAIs). The question specifies poor technique as a suspected cause, and the first step should focus on contextual factors that could influence technique variability.

Option A, stratifying infections by the location of IV insertion (pre-hospital, Emergency Department, or in-patient unit), is the most logical first step. Different settings may involve varying levels of training, staffing, time pressure, or adherence to aseptic technique, all of which can impact infection rates. For example, pre-hospital settings (e.g., ambulance services) may have less controlled environments or less experienced personnel compared to in-patient units, potentially leading to technique inconsistencies. The CDC’s Guidelines for the Prevention of Intravascular Catheter-Related Infections (2017) recommend evaluating the context of catheter insertion as a critical initial step in investigating BSIs, making this a priority for the IP to identify where the issue is most prevalent.

Option B, stratifying by the type of dressing used (gauze, CHG impregnated sponge, or transparent), is important but should follow initial location-based analysis. Dressings play a role in maintaining catheter site integrity and preventing infection, but their impact is secondary to the insertion technique itself. Option C, stratifying by the site of insertion (hand, forearm, or antecubital fossa), is also relevant, as anatomical sites differ in infection risk (e.g., the hand may be more prone to contamination), but this is a more specific factor to explore after broader contextual data is assessed. Option D, stratifying by the type of skin preparation used (alcohol, CHG/alcohol, or iodophor), addresses antiseptic efficacy, which is a key component of technique. However, without first understanding where the insertions occur, it’s premature to focus on skin preparation alone, as technique issues may stem from systemic factors across locations.

The CBIC Practice Analysis (2022) supports a stepwise approach to HAI investigation, startingwith broad stratification (e.g., by location) to guide subsequent detailed analysis (e.g., technique-specific factors). This aligns with the CDC’s hierarchical approach to infection prevention, where contextual data collection precedes granular process evaluation. Therefore, the IP should first stratify by location to establish a baseline for further investigation.

To determine the number of employees whoseroconverted(became infected) after aneedlestick exposure, we use the given data:

Total Needlestick Injuries:250

Needlestick Injuries Involving Bloodborne Pathogens:100

Seroconversion Rate:2%

Calculation:

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Why Other Options Are Incorrect:

A. 1:Incorrect calculation;2% of 100 is 2, not 1.

C. 5:Overestimates the actual number of infections.

D. 10:Exceeds the calculated value based on given data.

CBIC Infection Control References:

APIC Text, "Occupational Exposure and Seroconversion Risks"​.

APIC Text, "Bloodborne Pathogens and Needlestick Injury Prevention"​

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

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

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

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

In aretrospective case-control study, cases and controls are selected based on disease status. The case group is composed of individuals whohave the disease(cases), while the control group consists of individualswithout the disease. This design allows researchers to look back in time to assess exposure to potential risk factors.

Step-by-Step Justification:

Selection of Cases and Controls:

Cases: Individuals who already have the disease.

Controls: Individuals without the disease but similar in other aspects.

Direction of Study:

A retrospective study movesbackwardfrom the disease outcome to investigate potential causes or risk factors​.

Data Collection:

Uses past medical records, interviews, and laboratory results to determine past exposures.

Common Use:

Useful for studyingrare diseasessince cases have already occurred, making it cost-effective compared to cohort studies.

Why Other Options Are Incorrect:

B. without the disease:(Incorrect) This describes the control group, not the case group.

C. with the risk factor under investigation:(Incorrect) Risk factors are identified after selecting cases and controls.

D. without the risk factor under investigation:(Incorrect) The study investigates whether cases had prior exposure, not whether they lacked a risk factor.

CBIC Infection Control References:

APIC Text, Chapter on Epidemiologic Study Design​.