Cleaning, Disinfection, Sterilization
According to the Spaulding classification system for sterilization and disinfection of reusable medical devices, which category of items, due to their contact with sterile tissue or the bloodstream, requires sterilization?
a. Non-critical
b. Semi-critical
c. Critical
d. Maximum critical
C. Critical
Rationale: In the Spaulding classification, items are categorized based on their risk of transmitting infection if they are contaminated. Critical items are those that come into direct contact with sterile tissue or the bloodstream, and they pose a high risk of infection transmission if not properly sterilized. Examples of critical items include surgical instruments, implants, and catheters.
Isolation that indicated you should wear a gown and gloves and that you MUST wash your hands with soap and water is called this.
What is Contact Plus?
A female patient with diabetes is admitted with a nonhealing foot ulcer. The patient is septic with positive blood cultures and is taken to surgery for an incision and drainage of the wound. Among the following choices, which organism would most likely be the causative pathogen associated with the infection?
a. Candida auris
b. Group A Streptococcus
c. MRSA
d. Enterobacter cloacae
B. Group A Streptococcus
Rationale: Group A Streptococcus are frequently the source of skin and soft tissue infections. Diabetes is a risk factor for invasive Group A Streptococcus associated with lower-extremity infections and invasive disease.
A patient presents to the emergency department with jaundice, dark urine, and light-colored stools. The patient has a history of intravenous drug use. Which disease should the infection preventionist suspect?
a. Tuberculosis
b. Hepatitis A
c. Encephalitis
d. Hepatitis C
What is (d) Hepatitis C?
Rationale: People who have shared needles for injection drug use are at increased risk for Hepatitis C. Although many people do not have symptoms, those who do may have jaundice, dark urine, and light-colored stools. When such symptoms develop, they usually occur within 2 to 12 weeks after exposure. Hepatitis A is transmitted through contaminated food and water. Tuberculosis is airborne, and encephalitis can be transmitted through respiratory droplets and infected insects
A large hospital is set to launch new central line dressing change kits within 30 days, requiring training for approximately 2,000 staff members. Which of the following would be the most suitable training model for ensuring effective hands-on competency checkoff before the deployment date?
a. Video tutorials for self-paced learning
b. Train the trainer
c. Large group training sessions
d. Just-in-time training
What is (b) Train the trainer?
Rationale: The training of trainers (ToT) model is intended to engage master trainers in coaching new trainers who are less experienced with a particular topic or skill, or with training overall. A ToT workshop can build a pool of competent instructors who can then teach the material to other people. Participants in this type of workshop typically observe an experienced trainer teach and complete the exercises, and then practice teaching segments to other participants.
Before opening a sterile package in a healthcare setting, what steps should a healthcare professional take to ensure the integrity of the contents?
a. Verify the package’s color.
b. Check for the presence of manufacturer branding.
c. Examine the expiration date.
d. Confirm the package’s weight.
c. Examine the expiration date.
Rationale: To maintain the sterility of the contents and ensure patient safety, healthcare professionals should check the expiration date on sterile packages to ensure that the items inside are still within their shelf life. The other options are not relevant.
A pediatric patent is admitted to an acute care hospital with Koplik spots, sensitivity to light, and cold-like symptoms. The types of PPE the IP should require for staff entering the patient's room is called this.
What is an N95 respirator or powered air purifying respirator (PAPR) or Airborne Precautions?
A 54-year-old man sought treatment at the emergency department NOTES for a painful and progressive erythematous rash. The lesions began on his distal extensor extremities and progressed to involve his trunk and face. Affected areas appear pale (hypopigmented) and are numb. Fite stains revealed the presence of acid-fast bacilli. What is the most likely diagnosis?
a. Leishmaniasis
b. Vitiligo
c. Epidermolysis Bullosa
d. Leprosy
d. Leprosy
Rationale: Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae and usually affects the skin and peripheral nerves but can have a wide range of possible clinical manifestations. The disease manifests commonly through skin lesion and peripheral nerve involvement. Leprosy is diagnosed by finding at least one of the following cardinal signs: (1) definite loss of sensation in a pale (hypopigmented) or reddish skin patch; (2) thickened or enlarged peripheral nerve, with loss of sensation and/or weakness of the muscles supplied by that nerve; (3) microscopic detection of bacilli in a slit-skin smear. Transmission of leprosy has not been fully elucidated. Prolonged person to-person contact through respiratory droplets is the most widely recognized route of transmission. Leprosy is a neglected tropical disease (NTD) that still occurs in more than 120 countries; it is now a growing challenge in parts of North America
A Hepatitis B (HBV)-vaccinated healthcare worker (HCW) was exposed to blood from a source patient with the following serologies:
• HBsAg negative
• Total anti-HBc negative
• Anti-HBs positive
What follow up, if any, should be performed by Employee Health in
treating this HCW?
a. No follow-up necessary as the source patient has resolved the infection.
b. No follow-up required unless the HCW becomes symptomatic.
c. Offer the Hepatitis B immune globulin (HBIG) and reinitiate HBV vaccine series.
d. No follow-up needed as both the source patient and exposed HCW are immune to Hepatitis B.
What is (d) No follow-up needed, as both the source patient and exposed HCW are immune to Hepatitis B?
Rationale: These results indicate that the source patient is immune to Hepatitis B (HBV) due to prior vaccination. Given that the source patient is immune to HBV and the healthcare worker is already vaccinated against HBV, there is no need for further follow-up or intervention. Both individuals are protected against Hepatitis B, so there is no risk of transmission or infection in this scenario.
The infection preventionist determines that employees are not donning and doffing personal protective equipment appropriately. Which of the following types of teaching method would be most effective in addressing this issue?
a. Demonstration and observation
b. Lecture and exam
c. Peer-to-peer mentoring sessions
d. Online self-paced modules
What is (a) Demonstration and observation?
Rationale: Demonstrating the appropriate donning and doffing technique followed by observation of participants’ technique allows for just-in-time education and correction of incorrect practices.
The infection preventionist is consulted regarding a high-level disinfection process for vaginal probes. When selecting a disinfection process, which of the following is most important from an infection prevention perspective?
a. Cost-effectiveness of the disinfection process
b. Ensuring that use of the disinfectant does not cause respiratory irritation
c. Effectiveness of the disinfection process against non-enveloped viruses
d. Length of time for effective disinfection
C. Effectiveness of the disinfection process against non-enveloped viruses
Rationale: Human papillomavirus (HPV), a non-enveloped virus, poses a significant transmission risk through various types of probes, including transvaginal, endovaginal, and endorectal transducers, as evidenced by documented cases. It is crucial to note that certain disinfectants may lack effectiveness against non-enveloped viruses such as HPV. Therefore, in the reprocessing of items such as vaginal probes, it is imperative to select a disinfection method effective against non-enveloped viruses.
This is a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered.
What are standard precautions?
The infection preventionist is notified of a patient in the Emergency Department who presents with fever, malaise, lethargy, and large hematoma-type bruises under the skin. The patient has recently traveled to Africa. In this scenario, what infectious disease would be of utmost concern to you as the infection preventionist?
a. Viral hemorrhagic fever
b. Zika virus
c. Cholera
d. Scarlet fever
a. Viral hemorrhagic fever
Rationale: Viral hemorrhagic fevers (VHFs) are a group of diseases that are caused by several distinct families of viruses. The term “viral hemorrhagic fever” refers to a condition that affects many organ systems of the body, damages the overall cardiovascular system, and reduces the body’s ability to function on its own. Symptoms of this type of condition can vary but often include bleeding or hemorrhaging. Some types of VHF cause relatively mild illness, while others can cause severe, life-threatening disease. Most types of VHF have no known cure or vaccine. VHFs are rare in the U.S., but they can be found in parts of Africa, Asia, and South America. VHFs can be transmitted between humans. Therefore, patients with confirmed or suspected cases should be placed in appropriate Transmission-Based Precautions, with healthcare personnel strictly adhering to personal protective equipment, hand hygiene, and surface disinfection requirements.
A hemodialysis patient receives a new positive result for anti-Hepatitis C virus (HCV) antibodies. What is the appropriate next step in managing this situation?
a. Administer Hepatitis C immunoglobulin.
b. Conduct follow-up nucleic acid testing on the patient to check for the presence of HCV RNA.
c. Arrange for the patient’s dialysis to occur in a private room using dedicated medical equipment.
d. Perform HCV nucleic acid testing on all other dialysis patients.
What is (b) Conduct follow-up nucleic acid testing on the patient to check for the presence of HCV RNA?
Rationale: A positive anti-HCV antibody test may indicate either current Hepatitis C virus (HCV) infection or resolved past infection. Any patient with a positive anti-HCV antibody result should be further tested for HCV RNA and referred for consideration of treatment if the results are positive. HCV-infected patients do not need to be isolated and the use of dedicated dialysis machines is not recommended.
Any HCV seroconversion in a dialysis facility patient should be treated as a possible transmission at the facility and should be investigated thoroughly. Next steps in the process include notifying local/state health authorities, as well as reviewing the patient chart and interviewing the patient to identify HCV risk factors and assess whether HCV infection may have occurred outside of the dialysis facility. If transmission could have occurred at the facility, a thorough investigation should be conducted
In exploring strategies for reducing catheter-associated urinary tract infections (CAUTI), which approach would best synthesize findings from multiple studies to provide a comprehensive understanding of the effectiveness of various interventions?
a. Meta-analysis
b. Qualitative case studies
c. Randomized controlled trials
d. Comparative effectiveness research
What is (a) Meta-analysis?
Rationale: A meta-analysis of existing studies involves statistically combining the results of multiple studies to draw conclusions about the overall effect of interventions. This approach provides a rigorous synthesis of evidence across various studies, offering a comprehensive understanding of intervention effectiveness. Therefore, it is the most appropriate option for synthesizing findings from multiple studies to assess the effectiveness of interventions for reducing catheter-associated urinary tract infections (CAUTIs).
The infection preventionist (IP) is consulted regarding updated endoscope reprocessing guidelines. The manufacturer’s instructions for use do not state the maximum amount of time that should lapse between the pre-cleaning and manual cleaning. What should the IP recommend?
a. Reprocess scopes as soon as possible according to patient flow and available resources.
b. Pre-clean the endoscope within 30 minutes and conduct manual cleaning within two hours.
c. The multidisciplinary team should conduct a risk assessment; however, a general time should be a maximum of one hour.
d. Follow a standardized reprocessing protocol used by similar healthcare facilities
C. The multidisciplinary team should conduct a risk assessment; however, a general time should be a maximum of one hour.
Rationale: Per Association for the Advancement of Medical Instrumentation (AAMI) ST91, it is important to ensure that cleaning is initiated in the timeframe prescribed in the manufacturer’s written instructions for use. If no timeframe is given, manual cleaning should be initiated within one hour or as determined by the facility based on their own documented risk assessment
When interacting with staff members who are repeatedly non-adherent with using PPE for patients on Transmission- Based precautions, what is the best trait for an IP to possess with the delivery of challenging information?
What is Emotional Intelligence which is the ability to recognize, understand, and manage our own emotions and recognize, understand, and influence the emotions of others?
An immunosuppressed cystic fibrosis patient developed ventilator associated pneumonia and grew gram-negative rods in the sputum. Which one of the following organisms is most likely responsible?
a. Shigella dysenteriae
b. Staphylococcus aureus
c. Stenotrophomonas maltophilia
d. Stomatococcus mucilaginosis
c. Stenotrophomonas maltophilia
Rationale: Stenotrophomonas maltophilia is an aerobic gram-negative rod that naturally inhabits water and colonizes immunosuppressed individuals and cystic fibrosis patients. In immunosuppressed patients with cystic fibrosis, particularly those with ventilator-associated pneumonia, infections caused by opportunistic pathogens such as Stenotrophomonas maltophilia are common. This multidrugresistant gram-negative bacterium is often isolated from respiratory specimens in hospitalized patients, especially those with underlying lung diseases or receiving mechanical ventilation. Shigella dysenteriae, is a gram-negative bacterium that typically causes gastrointestinal infections characterized by severe diarrhea. It is not commonly associated with cystic fibrosis or ventilator-associated pneumonia. The other two answer options are gram-positive organisms
All of the 72 patients in a chronic hemodialysis center were tested for Hepatitis C virus (HCV). Eight of the patients were identified as HCV positive. What is the prevalence?
a. 0.9%
b. 9%
c. 1%
d. 11%
What is (d) 11%?
This prevalence rate is calculated as: 8 ÷ 72 × 100 = 11%
Rationale: A prevalence rate is the proportion of persons in a population with a particular disease or attribute at a specific point in time (point prevalence) or over a specified time period (period prevalence). Prevalence depends on the duration of disease. The prevalence rate equals the number of existing cases of disease from a specified interval or point in time divided by the population at risk for same time period multiplied by a constant (k). k = A constant used to transform the result of division into a uniform quantity so that it can be compared with other, similar quantities. A whole number (fractions are inconvenient) such as 100, 1,000, 10,000, or 100,000 is usually used (selection of k is usually made so that the smallest rate calculated has at least one digit to the left of the decimal point) or is determined by accepted practice (the magnitude of numerator compared with denominator).
This prevalence rate is calculated as: 8 ÷ 72 × 100 = 11%
The infection preventionist at a large hospital system is conducting research on the association of social determinants of health and infection related events. In which of the following examples would artificial intelligence (AI) be most helpful?
a. Enhancing remote surveillance systems for early detection of infections.
b. Analyzing immunization histories based on socioeconomic status and prevalence of vaccine-preventable diseases.
c. Predicting patient infection risks based on comprehensive diagnostic data.
d. Integrating databases to correlate healthcare-associated infections with demographic and socioeconomic factors
What is (d) Integrating databases to correlate healthcare-associated infections with demographic and socioeconomic factors?
Rationale: Artificial intelligence (AI) can be immensely beneficial in integrating and analyzing large datasets efficiently. By connecting databases containing healthcare-associated infections (HAIs) with demographic and socioeconomic data, AI algorithms can identify patterns, trends, and correlations that may not be immediately apparent to human analysts. This integration allows for a deeper understanding of how social determinants of health influence the occurrence and spread of infections within specific populations. Additionally, AI can help in identifying high-risk groups based on socioeconomic factors, enabling targeted interventions and resource allocation to mitigate the risk of infections. Therefore, leveraging AI for this purpose can enhance the hospital system’s ability to address and mitigate infection-related events influenced by social determinants of health.
When is it appropriate to use immediate-use steam sterilization (IUSS) cycles? Select all that apply
a. When a specific instrument is needed for an emergency procedure and is not sterile
b. When a non-replaceable instrument has been contaminated and is needed for a procedure that cannot be rescheduled
c. When there is insufficient surgical instrumentation to meet the inventory needs
d. When an item falls on the floor and is needed to continue an in-process surgical procedure
e. All the above
A,B,D
a. When a specific instrument is needed for an emergency procedure and is not sterile
b. When a non-replaceable instrument has been contaminated and is needed for a procedure that cannot be rescheduled
d. When an item falls on the floor and is needed to continue an in-process surgical procedure
Rationale: Association for the Advancement of Medical Instrumentation (AAMI) Standards and Association of perioperative Registered Nurses (AORN) Guidelines agree that Immediate Use Steam Sterilization (IUSS) should be kept to a minimum and should only be used in situations where no other option is available. There may be a few situations where a facility may determine that running an IUSS cycle in an autoclave is the only option, if so, the facility should define what constitutes an emergency in their policy and procedures. Staff should be trained as to what constitutes an emergency, and some examples include: • When a specific instrument is needed for an emergency procedure and is not sterile • When a non-replaceable instrument has been contaminated and is needed for a procedure that cannot be rescheduled • When an item falls on the floor and is needed to continue an in-process surgical procedure • Not having enough instruments in inventory is not an acceptable reason for IUSS.
True or False: A sneeze only has droplets.
What is false?
A 70-year-old patient presents with symptoms of rapid neurological degeneration. The physician orders several diagnostic tests, including a 14-3-3 spinal fluid assay, an electroencephalogram (EEG), and magnetic resonance imaging (MRI). Which of the following is a possible diagnosis if the results are positive?
a. Meningitis
b. Alzheimer’s disease
c. Multiple sclerosis
d. Creutzfeldt-Jakob disease
d. Creutzfeldt-Jakob disease
Rationale: Classic Creutzfeldt-Jakob disease (CJD) is a human prion disease. It is a neurodegenerative disorder with characteristic clinical and diagnostic features. This disease is rapidly progressive and always fatal. Infection with this disease leads to death usually within one year of onset of illness. A probable diagnosis of CJD is made using the following algorithm: Probable: Rapidly progressive dementia; and at least two out of the following four clinical features: 1. Myoclonus 2. Visual or cerebellar signs 3. Pyramidal/extrapyramidal signs 4. Akinetic mutism AND a positive result on at least one of the following laboratory tests: • A typical EEG (periodic sharp wave complexes) during an illness of any duration; and/or • A positive 14-3-3 CSF assay in patients with a disease duration of less than two years • Magnetic resonance imaging high-signal abnormalities in caudate nucleus and/or putamen on diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR)
A healthcare worker sustains a needle stick while treating a patient who is Hepatitis B antigen (HBsAg) positive. The employee has not received the Hepatitis B vaccine. What recommendations should be given by employee health?
a. The exposed employee should receive the first dose of the Hepatitis B virus vaccine and one dose of Hepatitis B immunoglobulin (HBIG) as soon as possible.
b. The employee should receive HBIG as soon as possible. The Hepatitis B virus vaccine series should be started four weeks later.
c. The employee should start the Hepatitis B virus vaccine series. HBIG is not indicated.
d. No action is necessary. The laboratory result indicates that the patient is immune to Hepatitis B and is not actively infected.
What is (a) The exposed employee should receive the first dose of the Hepatitis B virus vaccine and one dose of Hepatitis B immunoglobulin (HBIG) as soon as possible?
Rationale: According to the Centers for Disease Control and Prevention, postexposure management is recommended for individuals who are exposed in an occupational or nonoccupational setting to the Hepatitis B virus through a distinct, identifiable exposure to blood or body fluids that contain blood. If the exposed individual is unvaccinated or incompletely vaccinated, the first dose of the Hepatitis B vaccine series and one dose of HBIG should be administered as soon as possible after exposure, and the individual should complete the entire Hepatitis B vaccine series according to the vaccine schedule.
Which of the following would be best studied utilizing qualitative research methods?
a. The effect of preoperative bathing with CHG on SSI rates
b. Declining influenza vaccination rates in HCP
c. MRSA colonization rates in dialysis patients
d. Reoccurrence of Clostridioides difficile in nursing home patients
What is (b) Declining influenza vaccination rates in healthcare workers (HCWs)?
Rationale: Qualitative research methods can be used to study phenomena of interest to infection preventionists (IPs), including HCWs adherence to infection prevention recommendations (e.g., immunization schedules, hand hygiene, and safe surgical techniques). By using qualitative methods, IPs can systematically identify variables and relationships among variables that influence the practices and behavior of HCWs, Qualitative research can be used to determine why HCWs are not receiving the flu vaccine.