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A 17-year-old presents to the Emergency Department with fever, stiff neck, and vomiting. A lumbar puncture is done. The Gram stain shows Gram negative diplocooci. Presumptive identification of the organism is
A. Haemophilus influenzae
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Listeria monocytogenes
Answer: B
Explanation:
The Gram stain showing Gram-negative diplococci in cerebrospinal fluid (CSF) is characteristic of Neisseria meningitidis, a leading cause of bacterial meningitis in adolescents and young adults.
Step-by-Step Justification:
* Gram Stain Interpretation:
* Gram-negative diplococci in CSF strongly suggest Neisseria meningitidis.
* Classic Symptoms of Meningitis:
* Fever, stiff neck, and vomiting are hallmark signs of meningococcal meningitis.
* Neisseria meningitidis vs. Other Bacteria:
* Haemophilus influenzae (Option A) # Gram-negative coccobacilli.
* Listeria monocytogenes (Option C) # Gram-positive rods.
* Streptococcus pneumoniae (Option D) # Gram-positive diplococci.
CBIC Infection Control References:
* APIC Ready Reference for Microbes, "Neisseria meningitidis and Meningitis".
NEW QUESTION # 29
Which of the following procedures has NOT been documented to contribute to the development of postoperative infections in clean surgical operations?
A. Shaving the site on the day prior to surgery
B. Prolonged preoperative hospital stay
C. The use of iodophors for preoperative scrubs
D. Prolonged length of the operations
Answer: C
Explanation:
Postoperative infections in clean surgical operations, defined by the Centers for Disease Control and Prevention (CDC) as uninfected operative wounds with no inflammation and no entry into sterile tracts (e.g., gastrointestinal or respiratory systems), are influenced by various perioperative factors. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes identifying and mitigating risk factors in the "Prevention and Control of Infectious Diseases" domain, aligning with CDC guidelines for surgical site infection (SSI) prevention. The question focuses on identifying a procedure not documented as a contributor to SSIs, requiring an evaluation of evidence-based risk factors.
Option C, "The use of iodophors for preoperative scrubs," has not been documented to contribute to the development of postoperative infections in clean surgical operations. Iodophors, such as povidone-iodine, are antiseptic agents used for preoperative skin preparation and surgical hand scrubs. The CDC's "Guideline for Prevention of Surgical Site Infections" (1999) and its 2017 update endorse iodophors as an effective method for reducing microbial load on the skin, with no evidence suggesting they increase SSI risk when used appropriately. Studies, including those cited by the CDC, show that iodophors are comparable to chlorhexidine in efficacy for preoperative antisepsis, and their use is a standard, safe practice rather than a risk factor.
Option A, "Prolonged preoperative hospital stay," is a well-documented risk factor. Extended hospital stays prior to surgery increase exposure to healthcare-associated pathogens, raising the likelihood of colonization and subsequent SSI, as noted in CDC and surgical literature (e.g., Mangram et al., 1999). Option B,
"Prolonged length of the operations," is also a recognized contributor. Longer surgical durations are associated with increased exposure time, potential breaches in sterile technique, and higher infection rates, supported by CDC data showing a correlation between operative time and SSI risk. Option D, "Shaving the site on the day prior to surgery," has been documented as a risk factor. Preoperative shaving, especially with razors, can cause microabrasions that serve as entry points for bacteria, increasing SSI rates. The CDC recommends avoiding shaving or using clippers immediately before surgery to minimize this risk, with evidence from studies like those in the 1999 guideline showing higher infection rates with preoperative shaving.
The CBIC Practice Analysis (2022) and CDC guidelines focus on evidence-based practices, and the lack of documentation linking iodophor use to increased SSIs-coupled with its role as a preventive measure-makes Option C the correct answer. The other options are supported by extensive research as contributors to SSI development in clean surgeries.
References:
* CBIC Practice Analysis, 2022.
* CDC Guideline for Prevention of Surgical Site Infections, 1999, updated 2017.
* Mangram, A. J., et al. (1999). Guideline for Prevention of Surgical Site Infection. Infection Control and Hospital Epidemiology.
NEW QUESTION # 30
Hand hygiene rates in the facility have been decreasing over time. The Infection Preventionist (IP) surveys staff and finds that hand dryness is the major reason for non-compliance. What step should the IP take?
A. Allow staff to bring in lotion for use at the nurses' station and lounge.
B. Provide a compatible lotion in a convenient location.
C. Provide staff lotion in every patient room.
D. Allow staff to bring in lotion and carry it in their pockets.
Answer: B
Explanation:
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.
References:
* CBIC Practice Analysis, 2022.
* CDC Guideline for Hand Hygiene in Healthcare Settings, 2002.
* WHO Guidelines on Hand Hygiene in Health Care, 2009.
NEW QUESTION # 31
Peripherally inserted central catheter (PICC)-associated bloodstream infections (BSIs) have been increasing over the past four months. Which of the following interventions is MOST likely to have contributed to the increase?
A. Use of a positive pressure device on the PICC
B. Replacement of the intravenous administration sets every 72 hours
C. Daily bathing adult intensive care unit patients with chlorhexidine
D. Use of chlorhexidine skin antisepsis during insertion of the PICC
Answer: B
Explanation:
Peripherally inserted central catheter (PICC)-associated bloodstream infections (BSIs) are a significant concern in healthcare settings, and identifying factors contributing to their increase is critical for infection prevention. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the
"Surveillance and Epidemiologic Investigation" and "Prevention and Control of Infectious Diseases" domains, which align with the Centers for Disease Control and Prevention (CDC) guidelines for preventing intravascular catheter-related infections. The question asks for the intervention most likely to have contributed to the rise in PICC-associated BSIs over four months, requiring an evaluation of each option based on evidence-based practices.
Option C, "Replacement of the intravenous administration sets every 72 hours," is the most likely contributor to the increase. The CDC's "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (2017) recommend that intravenous administration sets (e.g., tubing for fluids or medications) be replaced no more frequently than every 72-96 hours unless clinically indicated (e.g., contamination or specific therapy requirements). Frequent replacement, such as every 72 hours as a routine practice, can introduce opportunities for contamination during the change process, especially if aseptic technique is not strictly followed. Studies cited in the CDC guidelines, including those by O'Grady et al. (2011), indicate that unnecessary manipulation of catheter systems increases the risk of introducing pathogens, potentially leading to BSIs. A change to a 72- hour replacement schedule, if not previously standard, could explain the observed increase over the past four months.
Option A, "Use of chlorhexidine skin antisepsis during insertion of the PICC," is a recommended practice to reduce BSIs. Chlorhexidine, particularly in a 2% chlorhexidine gluconate with 70% alcohol solution, is the preferred skin antiseptic for catheter insertion due to its broad-spectrum activity and residual effect, as supported by the CDC (2017). This intervention should decrease, not increase, infection rates, making it an unlikely contributor. Option B, "Daily bathing adult intensive care unit patients with chlorhexidine," is another evidence-based strategy to reduce healthcare-associated infections, including BSIs, by decolonizing the skin of pathogens like Staphylococcus aureus. The CDC and SHEA (Society for Healthcare Epidemiology of America) guidelines (2014) endorse chlorhexidine bathing in intensive care units, suggesting it should lower, not raise, BSI rates. Option D, "Use of a positive pressure device on the PICC," aims to prevent catheter occlusion and reduce the need for frequent flushing, which could theoretically decrease infection risk by minimizing manipulation. However, there is no strong evidence linking positive pressure devices to increased BSIs; if improperly used or maintained, they might contribute marginally, but this is less likely than the impact of frequent tubing changes.
The CBIC Practice Analysis (2022) and CDC guidelines highlight that deviations from optimal catheter maintenance practices, such as overly frequent administration set replacements, can increase infection risk.
Given the four-month timeframe and the focus on an intervention's potential negative impact, Option C stands out as the most plausible contributor due to the increased manipulation and contamination risk associated with routine 72-hour replacements.
References:
CBIC Practice Analysis, 2022.
CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2017.
O'Grady, N. P., et al. (2011). Guidelines for the Prevention of Intravascular Catheter-Related Infections.
Clinical Infectious Diseases.
SHEA Compendium, Strategies to Prevent Central Line-Associated Bloodstream Infections, 2014.
NEW QUESTION # 32
What rate is expressed by the number of patients who acquire infections over a specified time period divided by the population at risk of acquiring an infection during that time period?
A. Disease specific
B. Period prevalence
C. Incidence rate
D. Point prevalence
Answer: C
Explanation:
Theincidence ratemeasuresnew cases of infection in a population over a defined time periodusing the formula:
Why the Other Options Are Incorrect?
* B. Disease specific- Refers to infectionscaused by a particular pathogen, not the general rate of new infections.
* C. Point prevalence- Measuresexisting cases at a specific point in time, not new cases.
* D. Period prevalence- Includesboth old and new cases over a set period, unlike incidence, which only considers new cases.
CBIC Infection Control Reference
APIC definesincidence rate as the number of new infections in a population over a given period.
NEW QUESTION # 33
......
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