1. Questions and answers APIC Greater NY Chapter 13 ~ October 17, 2018
Leonel Destin MD
Associate Professor at Hostos Community College, Bronx, New York. City University of New York
Teaching Microbiology, Immunology, Anatomy and Physiology
Associate professor at Hudson Community College, Jersey City, New Jersey
Teaching Epidemiology, Microbiology, infection Prevention, Immunology and Anatomy and Physiology

2. 1) The IP has been benchmarking her data to other facilities performing similar activities for a period of time. The IP should analyze the entire process to ensure that which of the following condition are met?
Standardized definitions are used consistently
Overall rates are used to accurately track trend over time.
Adequate training of personnel to collect, store, manage and analyze data
Data are calculated using the same methodology as a nationally validated system
1, 2, 3
2, 3, 4
1, 3, 4
1, 2, 4

3. 1) Answer C. 1, 3, 4
Rationale: To accurately trend surveillance data over time within a facility or compare rates between a facilities, surveillance criteria (i.e., case definitions) must be consistently used to determine the presence of an HAI, occurrence of an event, or compliance with a process.
Rates, rather than raw numbers, must be used to accurately track trends over time. Personnel who are responsible for collecting and managing surveillance data must have adequate training in reviewing medical records, interpreting clinical notes, applying standardized criteria for identifying cases, using appropriate statistical and risk adjustment methods, and using computer tools and technology (especially electronic records, spreadsheets and databases ) to collect, store, manage, and analyze data.
Whenever possible, data should be expressed as rates or ratios that are calculated using the same methodology as a nationally validated surveillance system. This allows an organization to compare its rate with another organization or recognized benchmark.

4. 2) An “antibiotic time out” occurs:
Daily
Weekly
Within 24 to 48 hours of culture results being available
Within 96 hours of culture results being available

5. 2) Answer C. Within 24 to 48 hours of culture results being available
Rationale: Much antimicrobial prescribing is unnecessary or inappropriate. The CDC has advocating for implementing taking an “antibiotic time out” (ATO) whereby prescribing clinicians formally assess three pieces of essential information during clinical rounds: correct dosing, duration of therapy, and indication for treatment. An ATO should be taken when culture results are available, usually within 24 to 48 hours.

6. 3) A patient with bacterial meningitis due to Neisseria meningitidis requires what type of transmission-based precautions?
Contact Precautions
Standard Precautions
Droplet Precautions
Airborne Precautions

7. 3) Answer C. Droplet precautions
Rationale. Neisseria meningitidis is an aerobic, gram-negative diplococcus that colonizes nasal pharynx of many healthy individuals. Microbial and host factor combine to allow the organism to invade the blood and enter the nervous system, causing severe sepsis and meningitis. Hypervirulent strains may be transmitted from person to person through respiratory secretions, causing outbreak of meningococcal disease.
Rapid identification of the pathogen, institution of droplet precaution based on suspicion of meningococcal disease, initiation of appropriate antibiotic therapy, and administration of chemoprophylaxis of health care personnel who were indirect contact with the patient nasopharyngeal secretions are the most important interventions.

8. 4) There has been a local bioterrorism event and three healthcare personnel were exposed to inhalation anthrax. They have been decontaminated and are taking PEP. They would like to return to work. The incubation period for inhalation anthrax is usually about 1-7 days but can be as long as 60 days.
For these employees,
They will not be allowed to return to work for the duration of the 2 month incubation period
They will not be allowed to return to work for the duration of prophylactic treatment
They may return to work but must wear respiratory protection while in the facility
They main return to work with no restriction

9. 4) Answer D. They may return to work with no restriction
Rationale: Although work restriction in such scenario would likely be influenced by outside agencies such as the local and state health departments and the CDC, inhalation anthrax is not transmissible among human so these exposed healthcare workers pose no risk to patients and other employees.

10. 5) Healthcare workers in your facility have requested that Environmental Services purchase a hydrogen peroxide vapor unit to decontaminate patient care rooms. The administrator would like you to work with the director of Environmental Services to determine the pros and cons of this technology.
Which of the following is accurate argument in favor of using the technology?
It is effective at disinfecting all surface and supplies in the room
It cuts down on room turnaround time because personnel don’t to clean the room before disinfection
The room can be occupied during the process so it is useful for daily cleaning
The heating, ventilation, and air condition (HVAC) system does not need to be turned off while the unit is being used

11. 5) Answer A. It is effective at disinfecting all surface and supplies in the room
Rationale: Vaporized hydrogen peroxide units are useful for room disinfection after terminal cleaning, especially if there is concern for environmental contamination with clostridium difficile. The hydrogen peroxide vapor usually reaches all surface in the room, including fabrics and all behind furniture. It is also useful for disinfecting patient care items in the room and is safe for use in the presence of patient care equipment.
However, the patient room must be cleaned prior to disinfection in order to remove organic material and hydrogen peroxide vapor must be contained in the patient room during disinfection process.

12. 6) Which of the following situations would be best for the IP to apply just-in time learning principles?
During a 30 minutes orientation session for new employees
With staff who repeatedly have problems applying infection definitions
In a medical staff meeting where surveillance priorities are being discussed
For nurse managers evaluation evaluating monthly infection trend reports.

13. 6) Answer B. With staff who repeatedly have problem applying infection definitions
Rationale: Just in time teaching (JITT) is a methodology that uses feedback between class room activities and work students do at home, in preparation for the classroom meeting. The goals are to increase learning during classroom time, to enhance student motivation, to encourage students to prepare for class, and to enable the instructor to fine-tune the class room activities to best meet students’ needs.
JITT assignments and classroom activities are designed to motivate students to examine their present knowledge and get ready to modify such knowledge, add to it, and then apply the newly constructed knowledge. These tasks are accomplished as students and instructors work as a team.

14. 7) Elements of a ventilator-associated pneumonia (VAP) prevention bundle that have been suggested by the Institute for Healthcare Improvement (IHI) include all of the following except:
Elevation of the head of the bed
Weekly “sedation vacation” and assessment of readiness to extubate
Peptic ulcer disease prophylaxis
Deep venous thrombosis prophylaxis

15. 7) Answer B. Weekly “sedation vacation” and assessment of readiness to extubate
Rationale: VAP in a critically ill patient significantly increases the risk of mortality and, at a minimum, increases ventilator time, length of stay, and cost of care.
The IHI ventilator bundle is a grouping of best practices that, when applied together, may result in substantially greater improvement. The key components of the IHI ventilator bundle are:
-Elevation of the head of the bed
-Daily “sedation vacation” and assessment of readiness to extubate
-Peptic ulcer disease prophylaxis
-Deep venous thrombosis prophylaxis
-Daily oral care with chlorhexidine gluconate

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

17. 8) Answer D. The number of true negatives divided by the total number of persons without the disease, times 100
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 negative that are correctly identified as such (e.g., the percentage of healthy people who are correctly identified as not having the condition)

18. 9) Which of the following statements about influenza is false?
Influenza is primarily spread between individuals via respiratory secretions (droplets)
Viral shedding stars 48 to 72 hours after infection and typically 48 hours before the onset of symptoms
Viral shedding normally persists for less than 5 days but can longer in children and immunocompromised persons
The typical influenza symptomology is not always predictive of influenza in elderly or immunocompromised persons

19. 9) Answer B. Viral shedding starts 48 to 72 hours after infection and typically 48 hours before the onset of symptoms
Rationale. Influenza viruses are spread from person to person primarily through large-particle respiratory droplet transmission. Transmission via large – droplet particle requires close contact between source and recipient, because droplet do not remain suspended in the air and generally travel a short distance (< 1 meter) through the air. Contact with respiratory- droplet contaminated surfaces is another possible source of transmission.
The typical incubation period for influenza is 1 to 4 days (average 2 days). Adults shed influenza from the day before symptoms begin through 2 to 10 days after illness onset. However, the amount of virus shed and presumably infectivity, usually decreases rapidly by 3 to 5 days after onset. Young children might shed virus several days before illness onset, and children can be infectious for 10 or more days after onset of symptoms. Severely immunocompromised persons can shed virus for weeks or months.