CIC Prep Questions Employee Health

1. Nursing personnel are concerned about acquiring hepatitis B from hepatitis B surface antigen (HBsAg) positive postpartum patients. Which of the following should the ICP recommend? Screening does nothing for prevention Discussion: What does HBsAg+ mean? Active vs. passive immunization Screen personnel annually for HBsAg Immunize personnel with hepatitis B vaccine and teach barrier precautions Give hepatitis B immune globulin to personnel with blood contact Screen postpartum patients for hepatitis B Screening does nothing for prevention, this is after BBFE

2. A new employee with a purified protein derivative (PPD/TST) skin test of 0 mm induration is exposed to pulmonary tuberculosis the first day on the job. When should the post-exposure PPD skin test be repeated? 1 week 8 weeks 12 weeks 15 weeks Discussion: What is PPD testing? Timing of immune response 1. Slow growth of MTB means longer time to immune response (6-8 weeks) 2. Want to avoid PPD prior to IgG/IgM response (less than 8-10 weeks) 3. Want to avoid potential development of clinical disease Slow growth of MTB means longer time to immune response (6-8 weeks) Want to avoid PPD prior to IgG/IgM response (less than 8-10 weeks) Want to avoid potential development of clinical disease

3. An agency employing 230 homecare nurses reported eight needlestick injuries resulting from the use of lancets in spring-loaded devices. The FIRST intervention should be to design a poster on lancet use for each work site meet with the nurses individually to determine circumstances contributing to the injuries distribute the nurses' injury reports describing the circumstances of their injuries to the rest of the nursing staff call the manufacturer to report a product defect Discussion: What is the main problem? 1. Need to first understand the reasons for the injuries prior to implementing further interventions Must determine main problem prior to education/performance improvement

4. A nurse has been found to be a hepatitis B carrier 4. A nurse has been found to be a hepatitis B carrier. Counseling should include all of the following recommendations EXCEPT BBFE avoid sharing razors and toothbrushes do not provide direct patient care do not donate blood advise hepatitis B immunization for spouse Discussion: What is the problem? Is there a difference between carrier state and clinical disease? What risk factors are involved? BBFE BBFE Blood/Body Fluid exposures on A, C, D

5. A patient who has undergone cardiopulmonary resuscitation is subsequently diagnosed as having meningococcal meningitis. Which of the following employees should receive prophylaxis? anesthetist who performed endotracheal intubation physician who administered intravenous medications technician who performed the EKG nurse who performed chest compressions Discussion: What is the causative agent? What risk factors are involved? Definite aerosolization of saliva. BBFE risk Minimal BBFE risk Minimal BBFE risk Possible aerosolization of saliva. Moderate BBFE risk Intubation poses greatest risk of aerosolizing saliva, though chest compressions may do so as well

6. A nurse presents to the Employee Health office for the hepatitis B vaccine. The nurse explains that the vaccine series was started 24 months ago with two doses received. Which of the following should be recommended? Assess the nurse's exposure history and give third dose, if needed Check antibody titer and if inadequate, give the third dose Give the third dose and check antibody titer after 1 month Start the series of vaccine over again and check antibody titer Discussion: What is the normal range for HepB vaccination? This is an example of one where you really just have to know the current recommendations

Inform the worker that the patient's diagnosis is confidential 7. An environmental service worker refuses to enter a patient's room because he suspects that the patient is infected. What is the infection control practitioner's MOST appropriate response to the situation? Make certain a universal precautions placard is visible in the patient's room Inform the worker that the patient's diagnosis is confidential Arrange to have the worker reassigned Discuss with the employee his concerns about this situation Discussion: What is the main issue? Does not resolve fears Does not resolve fears Does not resolve fears, reinforces bad behavior May not resolve fears, but you can understand and educate employee Most correct = education issues Does nothing to resolve the fear Does not educate Discuss fears and educate

adequate infection control knowledge 8. An ICP observes that a nurse in the intensive care unit wears a glove only on her dominant hand while suctioning the airway of a patient who is being mechanically ventilated. The ICP should suspect that the nurse has adequate infection control knowledge adequate concern for airway clearance inadequate concern for the patient's risk inadequate concern for her personal risk No Discussion: What is the question asking? No Correct Correct the nurse is minimizing the invasive risk to the patient, but potentially exposing herself to BBF While both C and D are correct, the nurse is minimizing the invasive risk to the patient, but potentially exposing herself to BBF

9. At a facility with 2500 employees, 1500 are at risk for bloodborne pathogen exposure. Over the past 10 years, 250 of the 503 needlestick injuries involved exposure to known bloodborne pathogens. The ICP reports the percent of employees who seroconverted after exposure was 0.4%. How many employees became infected? 1 2 6 10 This is a retired question from CIC, not the most well-written one. They defined exposure as we would define a high-risk exposure, + BBF pathogens. Confusion comes from “exposure” that can be interpreted as any BBFE, but they specifically mean only true pathogen exposure. Discussion: MATH? Really? What do they define as an “exposure”? This is a retired question from CIC, not the most well-written one. They defined exposure as we would define a high-risk exposure, + BBF pathogens. =250*0.004=1 Confusion comes from “exposure” that can be interpreted as any BBFE, but they specifically mean only true pathogen exposure. 250 * 0.004 = 1

10. An employee seeks advice from the ICP regarding her right to compensation for medical bills related to an occupationally acquired hepatitis B infection. The employee had declined hepatitis B vaccination. The ICP's response should be occupationally acquired hepatitis B infection may be filed as Workers' Compensation even if hepatitis B vaccination was declined declination of the offer to receive hepatitis B vaccine removes the facility's liability for medical expenses resulting from the disease employee liability for hepatitis B infection is dependent upon whether or not the employee signed a formal hepatitis B declination form Workers' Compensation benefits do not apply to vaccine preventable illness Discussion: Does vaccine declination remove responsibility/liability Correct Vaccine declination does not remove responsibility/liability