A hospital is experiencing an increase in multidrug-resistant Acinetobacter baumannii infections in the intensive care unit (ICU). The infection preventionist's FIRST action should be to:
Correct Answer: B
Epidemiologic Investigation: * The first step in an outbreak response is to characterize cases by person, place, and time. * Identifying common exposures (e.g., ventilators, catheters, or contaminated surfaces) helps determine the source. * Why Other Options Are Incorrect: * A. Universal contact precautions: Premature; precautions should be tailored based on transmission patterns. * C. Environmental sampling: Should be done after identifying epidemiologic links. * D. Decolonization protocols: Not routinely recommended for Acinetobacter outbreaks. CBIC Infection Control References: * CIC Study Guide, "Epidemiologic Investigations in Outbreaks," Chapter 4.
Question 2
An infection preventionist is reviewing a wound culture result on a surgery patient. The abdominal wound culture of purulent drainage grew Staphylococcus aureus with the following sensitivity pattern: resistant to penicillin, oxacillin, cephalothin, and erythromycin; susceptible to clindamycin, and vancomycin. The patient is currently being treated with cefazolin. Which of the following is true?
Correct Answer: B
The scenario involves a surgical patient with a purulent abdominal wound culture growing Staphylococcus aureus, a common pathogen in surgical site infections (SSIs). The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes accurate interpretation of culture results and antibiotic therapy in the "Identification of Infectious Disease Processes" and "Prevention and Control of Infectious Diseases" domains, aligning with the Centers for Disease Control and Prevention (CDC) guidelines for managing SSIs. The question requires assessing the sensitivity pattern and current treatment to determine the correct statement. Option B, "The current therapy is not effective," is true. The wound culture shows Staphylococcus aureus resistant to oxacillin, indicating methicillin-resistant S. aureus (MRSA). The sensitivity pattern lists resistance to penicillin, oxacillin, cephalothin, and erythromycin, with susceptibility to clindamycin and vancomycin. Cefazolin, a first-generation cephalosporin, is ineffective against MRSA because resistance to oxacillin (a penicillinase-resistant penicillin) implies cross-resistance to cephalosporins like cefazolin due to altered penicillin-binding proteins (PBPs). The CDC's "Guidelines for the Prevention of Surgical Site Infections" (2017) and the Clinical and Laboratory Standards Institute (CLSI) standards confirm that MRSA strains are not susceptible to cefazolin, meaning the current therapy is inappropriate and unlikely to resolve the infection, supporting Option B. Option A, "The wound is not infected," is incorrect. The presence of purulent drainage, a clinical sign of infection, combined with a positive culture for S. aureus, confirms an active wound infection. The CBIC and CDC define purulent discharge as a key indicator of SSI, ruling out this statement. Option C, "Droplet Precautions should be initiated," is not applicable. Droplet Precautions are recommended for pathogens transmitted via respiratory droplets (e.g., influenza, pertussis), not for S. aureus, which is primarily spread by contact. The CDC's "Guideline for Isolation Precautions" (2007) specifies Contact Precautions for MRSA, not Droplet Precautions, making this false. Option D, "This is a methicillin-sensitive S. aureus (MSSA) strain," is incorrect. Methicillin sensitivity is determined by susceptibility to oxacillin, and the resistance to oxacillin in the culture result classifies this as MRSA, not MSSA. The CDC and CLSI use oxacillin resistance as the defining criterion for MRSA. The CBIC Practice Analysis (2022) and CDC guidelines stress the importance of aligning antimicrobial therapy with sensitivity patterns to optimize treatment outcomes. The mismatch between cefazolin and the MRSA sensitivity profile confirms that Option B is the correct statement, indicating ineffective current therapy. References: * CBIC Practice Analysis, 2022. * CDC Guidelines for the Prevention of Surgical Site Infections, 2017. * CDC Guideline for Isolation Precautions, 2007. * CLSI Performance Standards for Antimicrobial Susceptibility Testing, 2022.
Question 3
The infection preventionist observed a caregiver entering a room without performing hand hygiene.The BEST response would be to
Correct Answer: B
Immediate feedback is a best practice in behavior correction and performance improvement. In hand hygiene non-compliance, real-time intervention allows for immediate correction, education, and reinforcement of infection prevention policies. * TheAPIC/JCR Workbookrecommends: "Provide simulation training... that provides immediate feedback-for example, how to properly insert a urinary catheter or perform hand hygiene." This supports behavior change and staff learning. * TheAPIC Textemphasizes that real-time, direct feedback is more effective than passive measures like signage or delayed education campaigns. References: APIC/JCR Infection Prevention and Control Workbook, 4th Edition, Chapter 6 - Clinical Strategies
Question 4
To understand how their hospital-acquired infection rates compare to other health care settings, an infection preventionist (IP) plans to use benchmarking. Which of the following criteria is important to ensure accurate benchmarking of surveillance data?
Correct Answer: D
Benchmarking compares infection rates across healthcare facilities. For accurate benchmarking, case definitions must be standardized and adjusted for patient demographics, severity of illness, and other risk factors. Why the Other Options Are Incorrect? * A. Data collectors are trained on how to collect data - Training is necessary, but it does not directly ensure comparability between facilities. * B. Collecting data on a small population - A larger sample size increases accuracy and reliability in benchmarking. * C. Denominator rates selected based on an organizational risk assessment - Risk assessment is important, but standardized case definitions are critical for comparison. CBIC Infection Control Reference According to APIC, accurate benchmarking relies on using standardized case definitions that account for differences in patient populations.
Question 5
An infection control manager is training a new infection preventionist. In discussing surveillance strategies, which of the following types of hospital infection surveillance usually provides maximum benefit with minimum resources?
Correct Answer: A
A high-risk patient focus maximizes benefits while minimizing resource use in infection surveillance. Step-by-Step Justification: * Efficiency of High-Risk Surveillance: * Targeting ICU, immunocompromised patients, or surgical units helps detect infections where the risk is highest, leading to earlier interventions. * Resource Allocation: * Full hospital-wide surveillance is resource-intensive; focusing on high-risk groups is more efficient. * Why Other Options Are Incorrect: * B. Antibiotic monitoring: * Important for stewardship, but not the primary focus of infection surveillance. * C. Prevalence surveys: * Snapshot data only; does not provide ongoing monitoring. * D. Nursing care plan review: * Less direct in identifying infection trends. CBIC Infection Control References: * APIC Text, "Surveillance Strategies for Infection Prevention".
