2016 CIC Prep Questions Intermountain APIC

Which of the following indicators is most accurate for assessing whether surgical instruments have bene processed correctly in a steam sterilization cycle? Autoclave tape Chemical indicator Biological indicator The cycle indicator on the steam sterilizer

C. Biological Indicators (BI) A biological indicator is the only method of assuring that a steam sterilizer has reached the correct conditions to ensure sterility of products. Use of a BI provides reliable, qualitative evidence that all spore-forming organisms have been inactivated during the sterilization cycle.

Specificity of a test for infection or disease is calculated as: The number of true negatives divided by the number of positives found, times 100 The number of true negatives divided by the total number of persons with disease, times 100 The number of true positives divided by the total number of person with disease, times 100 The number of true negatives divided by the total number of person without disease, times 100

D. The number of true negatives divided by the total number of person without disease, times 100 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 (aka true negative rate) measure 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=true negatives/true negatives + false positives or d/(d+b)

#1: Fruit fly infestation A tech reports an infestation of fruit flies in the sterile instrument storage room. The sterile packs were temporarily removed and a pest management company was called in to eradicate the flies. The or staff wants to know whether they can use the sterile packs. Which of the following is the best response?

#1: Fruit fly infestation The or staff can use the packs without any reprocessing because there are no flies visible on the outside of the packs. The or staff can use the packs without any reprocessing if they open a test pack and don’t find any flies inside of it. The or staff don’t need to repack the items, but they do need to run the packs through the sterilizer again. They need to completely reprocess all of the items that were in the affected room.

#1: Fruit fly infestation The or staff can use the packs without any reprocessing because there are no flies visible on the outside of the packs. The or staff can use the packs without any reprocessing if they open a test pack and don’t find any flies inside of it. The or staff don’t need to repack the items, but they do need to run the packs through the sterilizer again. They need to completely reprocess all of the items that were in the affected room.

#1: Fruit fly infestation Rationale: The presence of any type of vermin can affect the integrity of the packaging and contaminate the contents. Fruit flies are small enough to crawl into the sterile packs and potentially contaminate the instruments. They could also become trapped in the packs and leave debris on the instruments. The instruments should be unwrapped, visually inspected, cleaned if necessary, and reprocessed. Reference: apic text, 4th edition, chapter 106 – sterile processing

#2: initial outbreak investigation The primary components of an initial outbreak investigation are Preparing a line list and epidemic curve Notifying key partners about the investigation Continuing case finding Initiating an analytical study

#2: initial outbreak investigation The primary components of an initial outbreak investigation: Preparing a line list and epidemic curve; initiating an analytical study Notifying key partners about the investigation; continuing case finding Preparing a line list and epidemic curve; notifying key partners about the investigation Continuing case finding; initiating an analytical study

#2: initial outbreak investigation The primary components of an initial outbreak investigation: Preparing a line list and epidemic curve; initiating an analytical study Notifying key partners about the investigation; continuing case finding Preparing a line list and epidemic curve; notifying key partners about the investigation Continuing case finding; initiating an analytical study

#2: initial outbreak investigation Rationale: In general, outbreak investigations can be divided into two major sections: the initial investigation and the follow up investigation, each having several components. primary components of initial investigation: 1) confirming the presence of the outbreak; 2) Alerting key partners about the investigation; 3) Performing a literature review; 4) Establishing a preliminary case definition; 5) developing a methodology for case finding; 6) preparing an initial line list and epidemic curve; 7) observing and reviewing potentially implicated patient care activities; and, 8) implementing infection control measures Reference: apic text, 4th edition, chapter 12 – outbreak investigations

#3: scabies! Contact precautions for a patient with scabies can be discontinued when the patient has received effective treatment for: 10 days 7 days 48 hours 24 hours

#3: scabies! Contact precautions for a patient with scabies can be discontinued when the patient has received effective treatment for: 10 days 7 days 48 hours 24 hours

Question 127 An outbreak of norovirus in a LTCF would most likely have an epidemic curve (epi curve) that:           a. indicated a common source of infection            b. indicated a propagated source of infection            c. indicated a point source of infection            d. indicated a common vehicle of infection

Rationale: Question 127 B Indicated a propagated source of infection Rationale: an epidemic curve gives a graphical display of the numbers of incident cases in an outbreak or epidemic, plotted over time. The form of the resulting distribution of cases can be used to propose hypotheses on the nature of the disease and its mode of transmission

Rationale: Question 127 (contd) A propagated source means that infections are transmitted from person to person in such a way that cases identified cannot be attributed to agent(s) through a single source. Propagated (continuing) source cases occur over a longer period than in common source transmission. Explosive epidemics resulting from person-to-person transmission may occur (e.g. chickenpox). If secondary and tertiary cases occur, intervals between peaks usually approximate average incubation period.

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

Rationale Question 130 Evaluation measurements must be consistent with the objectives of the program Rationale: The educator may use evaluation oat different points within the program development process using a variety of methods. Whatever evaluation methodology is used, evaluation measurements must be consistent with the objectives established for the educational program. Data must be gathered, tabulated, and analyzed to assess impact and make recommendations for curriculum revision before the next presentation.

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

Rationale Question 133 Measles Rationale: Measles (rubeola, 7-day measles) is a distinct clinical syndrome with characteristic prodrome respiratory tract symptoms (cough, coryza, and conjunctivitis), followed by a febrile exanthem and a recovery period that includes a persistent cough for many weeks. Measles occurs throughout the world. It is one of the most highly contagious infectious diseases in humans.

#1 Identification of Infectious Disease Processes A urine specimen collected from an indwelling urinary catheter was sent to the laboratory for culture and sensitivity testing. Culture results reported a colony count of 50,000 cfu/ml of E.coli. Sensitivity testing reported resistance to cephalosporin and sensitive to ciprofloxacin. This organism is an example of: Methicillin resistance Aminoglycoside resistance Extended-spectrum beta-lactam (ESBL) resistance Quinolone resistance

c) ESBL resistance Rationale: ESBLs are beta-lactamases found in common Gram-negative bacteria, such as E.coli and Klebsiella pneumoniae, which confer resistance to all beta-lactam drugs except the carbapenems. Klebsiella species and E.coli are the most common ESBL-producing pathogens. ESBLs are enzymes that mediate resistance to extended-spectrum (third generation) cephalosporins (e.g. ceftazadime, cefotaxime, and ceftriaxone) and monobactams (e.g., aztreonam) but do not affect cephamycins (e.g. cefoxitin and ceftotetan) or carbapenems (e.g. meropenem or imipenem).

c) ESBL resistance The presence of an ESBL-producing organism in a clinical infection can result in treatment failure if one of the above classes of drugs is used. ESBLs can be difficult to detect because they have different levels of activity against various cephalosporins.

#2 Surveillance & Epidemiologic Investigation The Employee Health Service has notified the IP that seven employees have P. aeruginosa folliculitis. Initial investigation reveals that six of the seven cases belong to the same health club. Working on the hypothesis that the whirlpool at the health club is associated with the infections, the IP decides to conduct a case-control study using two controls for each case.

#2 Surveillance & Epidemiologic Investigation Which of the following groups is the most appropriate control? Non-ill family members of the ill employees Non-ill hospital employees matched for age and sex Hospitalized patients with P. aerugiosa follculitis matched for age and sex Non-ill members of the health club matched for age and sex

d) Non-ill members of the health club matched for age and sex Rationale: Case-control studies begin with the identification of persons who have the outcome of interest. Then a control group of individuals without the outcome is selected for comparison. The selection of an appropriate control group is critical in that control patients must not only have the outcome of interest but also should be similar to the cases in the potential for exposure during the period of risk being evaluated.

d) Non-ill members of the health club matched for age and sex Controls are matched to cases on one or more attributes (i.e. age, gender, smoking status, etc.) Each case/control pair then has identical values on the matching factors. Therefore, the most appropriate controls would be non-ill members of the health club.

#3 Management & Communication Failure mode and effects analysis (FMEA) is used to examine adverse events and identify what went wrong and what might prevent it from happening again. Which statement best describes the mode element of FMEA? The way of operating or using a system or process, or a way or manner in which a thing is done. The results or consequences of an action. The detailed examination of the elements or structure of something-perhaps a process, substance, or situation. Lack of success, nonperformance, nonoccurrence, or breaking down or ceasing to function.

#3 Management & Communication Failure mode and effects analysis (FMEA) is used to examine adverse events and identify what went wrong and what might prevent it from happening again. Which statement best describes the mode element of FMEA? The way of operating or using a system or process, or a way or manner in which a thing is done. The results or consequences of an action. The detailed examination of the elements or structure of something-perhaps a process, substance, or situation. Lack of success, nonperformance, nonoccurrence, or breaking down or ceasing to function.

a) The way of operating or using a system or process, or a way or manner in which a thing is done Rationale: The FMEA tool is a proactive, preventive approach to identify potential failures and opportunities for error. The mode is described as the way of operating or using a system or process, or a way or manner in which a thing is done. A mode is the way or manner in which something, such as a failure, can happen. Combining the words “failure” and “mode”, a failure mode is the manner by which something can fail

a) The way of operating or using a system or process, or a way or manner in which a thing is done A failure mode generally describes the way the failure occurs and its impact on a process. Any step in a process can fail, and each failure may have many failure mode.

1. The bacterium most likely to be transmitted from mother to infant during labor and cause neonatal sepsis is: a. Escherichia coli b. Staphylococcus aureus c. Group B Streptococcus d. Group A Streptococcus

C. Group B Streptococcus Rationale: In group B Streptococcus (GBS) neonatal infection, heavy maternal colonization is associated with an increased risk for preterm labor, which in turn is a significant risk factor for neonatal infection. Intrauterine infection of the fetus therefore likely occurs via ascending spread of GBS from the vagina of a pregnant asymptomatically colonized woman and subsequent rupture of membranes before 37 weeks’ gestation.

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

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

3. Subjects are said to be randomly assigned when: a 3. Subjects are said to be randomly assigned when: a. They are assigned to experimental and control groups from a sample representative of the larger experimental group b. They have an equal chance of being assigned to either the experimental or the control group c. They are assigned to experimental and control groups so that the groups differ on a critical variable d. Both the researcher and the subject are blinded as to know whether the subject is in the control group or the experimental group.

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

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

C 1, 2, 3, 4 Rationale: Ethylene Oxide (ETO) sterilization is affected by four parameters. The concentration of gas should be between 450 and 1200 mg/l, the temperature range should be between 37 and 630C, relative humidity should be between 40 an d80 percent, and exposure time should be between 1 and 6 hours.

5. 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 study, 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 study, 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 to ensure that the allocation is unbiased. The RCT design minimizes bias and provide 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.