Environment of Care
The appropriate hot water temperature for laundering linen is:
a. 160°F
b. 140°F
c. 165°F
d. 145°F
What is: A. 160°F?
Rationale: Hot water also provides an effective means of destroying organisms. A temperature of at least 160°F (71°C) for a minimum of 25 minutes is recommended for hot water washing.
Most Healthcare-associated pathogens are transmitted from patient to patient via:
a. Improper isolation practices
b. Inadequate sterilization of medical instruments
c. Hands of Healthcare personnel
d. Ineffective disinfection of medical devices.
What is: C. Hands of Healthcare personnel?
A number of research studies have examined the relationship between nurse staffing levels and the risk of HAIs in the hospital setting. Which of the following statements has not been supported by the literature?
a. Patients in an intensive care unit (ICU) with lower levels of nurse staffing had an increased risk for ventilator associated pneumonia
b. The use of nonpermanent staff significantly increases a patient’s infection risk
c. A specific evidence-based nurse staffing level benchmark has been determined that is associated with decreased risk for HAI
d. There is a relationship between adequate numbers of direct care providers (nurses) and the likelihood that CDC guidelines will be followed
What is: C A specific evidence-based nurse staffing level benchmark has been determined that is associated with decreased risk for HAI?
Rationale: Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections. Furthermore, a number of researchers have found the level and/or the use of nonpermanent staff also significantly increases a patient’s infection risk. Despite these data, determination of a specific evidence-based nurse staffing level benchmark that is associated with decreased risk for HAI has not been determined.
The optimal time to collect a sputum specimen for acid-fast bacilli (AFB) testing to rule out TB would be:
a. First thing in the morning
b. After a respiratory treatment
c. Prior to the patient going to bed
d. Prior to a respiratory treatment
What is: A. First thing in the morning?
Rationale: Because pulmonary disease is the most common form of TB, patients with suspected TB should have a chest radiograph. If the radiograph is abnormal or the patient has respiratory complaints, sputum specimens should be collected for acid-fast bacilli (AFB) staining, culture, or other direct tests. The first sputum may be obtained on admission, but subsequent cultures are usually obtained in the morning on consecutive days. A total of three specimens collected on separate days is generally adequate, and once one specimen is AFB positive, subsequent samples are not needed. Specimens should be delivered promptly to the laboratory for processing.
Higher morbidity rates in chronic Hepatitis B virus (HBV) carriers are associated with a co-infection of which of the following:
a. Hepatitis A
b. Hepatitis D
c. Hepatitis C
d. Hepatitis E
What is: B. Hepatitis D?
Rationale: Hepatitis D, also known as “delta hepatitis,“ is a serious liver disease caused by infection with the Hepatitis D virus (HDV), which is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with HBV. HDV is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a co-infection with HBV or as superinfection in persons with HBV infection. There is no vaccine for Hepatitis D, but it can be prevented by Hepatitis B vaccination in persons who are not already HBV infected.
You have been asked to advise the design team of a new healthcare facility on the planning for an airborne infection isolation room (AIIR). Which of the following are correct recommendations for this type of room in a new facility?
1) The AIIR must have an audible alarm to indicate when negative airflow is not being maintained
2) If the AIIR is a permanent, dedicated negative airflow room, then the air should exhaust to the outside
3) The AIIR must have at least 12 air changes per hour
4) The AIIR is required to have an anteroom
a. 1, 2
b. 2, 3
c. 1, 2, 3
d. 1, 2, 3, 4
What is: B 2,3?
Rationale: Airborne infection isolation rooms (AIIR) should be maintained under negative air pressure to ensure that airborne infectious organisms are not ventilated into the facility’s corridor. These rooms must have at least 12 air changes per hour and newly constructed AIIR’s must have a visible means of monitoring air flow. Anterooms are not required but there must be an area outside the room that allows for hand washing and for storage and disposal of personal protective equipment. If an AIIR is a dedicated negative airflow room then it should be designed to allow for air to exhaust directly outside the facility.
The policy for therapy animals in healthcare facilities should include all of the following except:
a. Hand hygiene must be performed after contact with the animal.
b. Animal must be bathed within 24 hours prior to visiting the healthcare facility.
c. Animals must be healthy and current with immunizations.
d. Small animals are never allowed to sit on a patient's bed.
What is: d. Small animals are never allowed to sit on a patient's bed?
Rationale: if an animal is allowed on the patient's bed, a barrier such as a disposable cloth, towel, or sheet can be placed between the animal and the patient's linen. The barrier is disposed of when the animal leaves.
An ambulatory clinic will be transporting equipment to the local hospital for sterilization. The IP at the clinic has been asked to write a policy to ensure safe handling of the equipment by staff. The policy should include which of the following points on handling the instruments at the point of use?
1) Devices are to be cleaned before biofilm can form
2) Keep instrumentation moist to prevent bio-burden from drying
3) Instruments with lumens should be flushed with saline
4) Contaminated devices are to be placed in a sealed container to prevent exposure to staff and patients
a. 1, 3, 4
b. 2, 3, 4
c. 1, 2, 4
d. 1, 2, 3
What is: C 1,2,4
Rationale: Reprocessing contaminated equipment or instruments for sterilization begins at point of use. The end user is responsible for removing gross soil and debris and for rinsing items at the site of use. Instruments with lumens should be flushed with water (not saline, as salt is corrosive to most instruments). Every attempt should be made to keep instrument or equipment surfaces moist until they can be cleaned to facilitate the removal of soil. Applying enzymatic foam or gel cleaner, using wet towels placed within the set of used instruments, or presoaking used items in water or cleaning solution may also be done. Contaminated items should be placed in puncture-proof sealable containers and visibly labeled as biohazardous.
When reviewing the Gram stain of a person with a wound infection, the IP sees Gram-positive organisms in clusters.
Which organism would this most likely represent?
a. Streptococcus
b. Enterococcus
c. Corynebacterium
d. Staphylococcus
What is: D Staphylococcus?
Rationale: Staphylococcus is a genus of Gram-positive bacteria. Under the microscope, they appear round (cocci) and form in grape-like clusters. Staphylococcus includes at least 40 species. Of these, nine have two subspecies and one has three subspecies. Most are harmless and reside normally on the skin and mucous membranes of humans and other organisms. Found worldwide, they are a small component of soil microbial flora.
Because there is no vaccine for Hepatitis C, there have been national recommendations for prevention and control of Hepatitis C virus (HCV) infections. These include all but which recommendation?
a. Screening and testing of blood donors
b. Risk-reduction counseling and screening of persons at risk for Hepatitis C infection
c. A national registry for all healthcare personnel known to be Hepatitis C antibody positive
d. Adherence to Standard Precautions and safe work practices in healthcare settings
What is: C. A national registry for all healthcare personnel known to be Hepatitis C antibody positive?
Rationale: No vaccine against HCV infection exists. National recommendations for prevention and control of HCV infection, issued in 1998, emphasize primary prevention activities to reduce the risk for HCV transmission. These activities include screening and testing of blood donors, viral inactivation of plasma derived products, risk-reduction counseling and screening of persons at risk for HCV infection, and adherence to Standard Precautions and safe work practices in healthcare settings.
Bed bugs can survive without feeding for:
a. 48 hours
b. 24 days
c. 6 month
d. 1 year
What is: D 1 year?
Rationale: Immature bed bugs may live for several months without feeding, while adults may survive as long as one year without a meal. Under normal conditions, adult bed bugs will live for about ten to eleven months.
There is a bioterrorism event in a city. Patients are presenting the the Emergency Room with blurred vision, descending symmetrical flaccid paralysis, and respiratory failure. The most likely bioterrorism disease is:
a. Botulism
b. Pneumonic plague
c. Viral hemorrhagic fever
d. Smallpox
What is: a. Botulism?
Rationale: Botulism is a public health emergency. Botulism is a neuroparalytic illness caused by a toxin made by the bacterium C. botulinum. Symptoms of botulism include blurred vision, diplopia, dysarthria, dysphagia, symmetrical descending flaccid paralysis and respiratory failure. Prompt diagnosis and early treatment of botulism are essential to minimize the number of affected
persons and the severity of illness.
Which of the following describes the correct storage to maintain sterility of reprocessed items?
a. At least 12 inches below the ceiling, at least six inches above the floor, at least one inch from the outside wall, and on a rack with a solid bottom
b. At least 18 inches below the ceiling, at least six inches above the floor, at least one inch from the outside wall, and on a rack with a solid bottom
c. At least 18 inches below the ceiling, at least eight inches above the floor, at least two inches from the outside wall, and on a rack with a solid bottom
d. At least 18 inches below the ceiling, at least eight inches above the floor, at least one inch from the outside wall, and on a rack with a solid bottom
What is: C. At least 18 inches below the ceiling, at least eight inches above the floor, at least two inches from the outside wall, and on a rack with a solid bottom
Rationale: Proper storage of sterile, reprocessed items is critical for maintaining sterility. Items should be stored at least 18 inches below the ceiling and eight to ten inches above the floor. Storage should be at least two inches from the wall and if a rack is used then it should have a solid bottom to avoid contamination of items from dust on the floor.
While reviewing blood culture reports, you notice a note indicating that the specimen was received in the lab 3 hours after it was collected. You confirm with the microbiology supervisor. The acceptable transport time is:
a. Place specimen on ice and transport within one hour of collection
b. Within 24 hours of collection at room temperature
c. Equal to or less than 2 hours at room temperature
d. Equal to or greater than 4 hours if refrigerated
What is: C Equal or less than 2 hours at room temperature?
Rationale: The reliability and value of test results depends on numerous factors. Improper collection, transport, or processing of a specimen can decrease the quality of patient care or result in unnecessary additional testing or treatment. Blood Culture bottles must be transported to the Lab within a time frame equal to or less than two hours and must be maintained at room temperature.
Hepatitis A is diagnosed by the presence of:
a. Immunoglobulin G (IgG) for anti–Hepatitis D virus (HDV)
b. Hepatitis A virus (HAV) Immunoglobulin M (IgM)
c. Increase in anti-Hepatitis B virus (HBV)–related to previous Hepatitis B infection
d. HAV IgG
What is: B Hepatitis A immuoglobulin M (IgM)?
Rationale: The clinical case definition for acute viral hepatitis is (1) discrete onset of symptoms (e.g., nausea, anorexia, fever, malaise, or abdominal pain) and (2) jaundice or elevated serum aminotransferase levels. Because the clinical characteristics are the same for all types of acute viral hepatitis, Hepatitis A diagnosis must be confirmed by a positive serologic test for IgM antibody to HAV, or the case must meet the clinical case definition and occur in a person who has an epidemiologic link with a person who has laboratory confirmed Hepatitis A (i.e., household or sexual contact with an infected person during the 15 to 50 days before the onset of symptoms). IgM is the first antibody built during immune response and is indicative of current disease.
Green cleaning is a new approach to environmental cleaning that aims at reducing harm to human health and the environment while maintaining or improving the hygiene of the healthcare environment. Which of the following green strategies would be appropriate to implement?
1) Replacing floor strippers and finishes that contain heavy metals and asthmagens
2) Substituting disinfectant room cleaners with less toxic detergents
3) Employing carcinogen-free carpet cleaners
4) Introducing high-filtration vacuum cleaners
a. 1, 2, 4
b. 2, 3, 4
c. 1, 3, 4
d. 1, 2, 4
What is: C 1,3, 4?
Rationale: The effective use of disinfectants is part of a multibarrier strategy to prevent healthcare-associated infections. CDC Guidelines recommend that noncritical medical equipment surfaces should be disinfected with an EPA-registered low- or intermediate-level disinfectant. Current certification programs for green cleaning products and equipment do not cover EPA registered disinfectants.
A healthcare worker has called the IP to ask the reasoning behind the policy that prohibits employees who have patient contact from wearing artificial fingernails. Which of the following reasons would she give to this employee?
a. There is strong evidence that artificial nails are associated with HAIs.
b. HCP with artificial nails are more likely to have more Gram-negative bacteria under their nails than HCP with natural nails.
c. Artificial nails often puncture gloves, exposing the healthcare worker to blood and body fluids.
d. HCP with artificial nails do not perform hand hygiene as often as HCP with natural nails.
What is: B. HCP with artificial nails are more likely to have more Gram-negative bacteria under their nails than HCP with natural nails.
Rationale: Whether artificial nails contribute to the spread of HAIs is unknown. However, HCP with artificial nails are more likely to harbor Gram-negative organisms on their fingertips than are those with natural nails. This holds true both before and after hand washing.
The director has requested that the IP summarize the results of an education program presented to five different groups within the institution. The director specifically requests that the method used not only indicate the overall mean score for each group but also aid a simple comparative analysis for all who participated. The best data display technique to summarize these fi would be:
a. A line list
b. A pie chart
c. A bar chart
d. A spreadsheet
What is: B. A Pie chart?
Rationale: A pie chart is a circular chart divided into sectors, illustrating proportion. In a pie chart, the arc length of each sector (and consequently its central angle and area), is proportional to the quantity it represents. A pie chart is best suited for visually representing the overall mean score and allowing viewers to rapidly compare one group to another.
The microbiology lab calls the IP with a CSF Gram stain result. From an infection prevention and control standpoint, the most concerning result would be:
a. Gram-negative rods
b. Gram-positive cocci in pairs
c. Acid-fast bacilli
d. Gram-negative diplococci
What is: D. Gram-negative diplococci
Rationale: Growth of oxidase-positive colonies and Gram-negative diplococci with the right clinical context provides a presumptive identification of N. meningitidis.
During an inservice for new employees, the IP describes how Hepatitis B and human immunodeficiency virus (HIV) are transmitted. A major difference in the epidemiology of the two diseases is:
a. Presence of the causative agent in body fluids
b. The ability of the diseases to be transmitted during sexual intercourse
c. The risk of transmission through needlestick exposures
d. The potential for airborne transmission
What is: C. The risk of transmission through needlestick exposures?
Rationale: Infection with HBV is a well-recognized occupational risk for HCP. The risk of HBV infection is primarily related to the degree of contact with blood in the work place and also the HBeAg status of the source person. The risk of developing clinical hepatitis if the blood was positive for both HBsAg and HBeAg has been estimated at 22 to 31 percent. In contrast, the average risk of HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3 percent.
A major hurricane is forecast for your area and you need to plan for the possible contamination of potable water that is supplied to your facility. Which of the following should be included in your planning?
a. You should have at least one day’s worth of back up water supplies available
b. You will need one liter per day of drinking water for all patients and healthcare workers
c. All back up water must be stored on site for easy access
d. You will need at least 25 gallons of water per patient per day to maintain care
What is: D? You will need at least 25 gallons of water per patient per day to maintain care?
Rationale: In the event of a disaster, it is critical to ensure that there is a reliable supply of water available for drinking and for patient care activities. Individuals in the facility will need at least 2 liters of drinking water per day per person, and additional water will be needed for bathing, flushing toilets, dialysis, cooking, and other activities. It is estimated that a facility will need 25 gallons of water per patient per day to maintain these patient care activities. Water may be stored on-site or off-site but it must be accessible in the event of an emergency.
The infection preventionist (IP) on the Antimicrobial Stewardship Team is thinking of ways that he can support efforts and add to the success of the team in decreasing antimicrobial resistance.
Some of the activities that he can do to help with the mission of the team include:
1) Calculate multidrug-resistant organism (MDRO) infection rates
2) Detect asymptomatic carriers using active surveillance cultures
3) Use molecular typing for investigating outbreaks
4) Collect environmental cultures of isolation rooms
a. 2, 3, 4
b. 1, 3, 4
c. 1, 2, 4
d. 1, 2, 3
What is: d: 1, 2, 3
D 1, 2, 3
Rationale: Surveillance of MDROs is critical to an antimicrobial stewardship
program. IPs monitoring microbiology isolates to detect prevalence and
emergence of MDROs. IPs may also support antimicrobial stewardship efforts
in the following ways:
• Calculate MDRO incidence on the basis of clinical culture results
• Calculate MDRO infection rates
• Use molecular typing for investigating outbreaks
• Detect asymptomatic carriers using active surveillance cultures
Which one of the following best describes the difference between a common point source outbreak and a propagated outbreak?
a. Case fatality rates in common source outbreaks are higher
b. Person-to-person transmission is a feature of common source outbreaks
c. The attack rate in propagated outbreaks is higher
d. All cases in a common point source outbreak occur within one incubation period of the exposure
What is: D All cases in a common point source outbreak occur within one incubation period of the exposure?
Rationale: A common source epidemic is characterized by a rapid spread with cases presenting at the same stage of the disease, indicating the single source of the pathogen. Propagated outbreaks are outbreaks in which the disease propagates in one or more initial cases and then spreads to others, a relatively slow method of spread.
There is a flu outbreak in a community, and the IP at the local hospital is interested in accurately identifying infected patients as quickly as possible so that they can be placed on Isolation Precautions. The IP has a choice between two rapid flu tests. Test A has a sensitivity of 98 percent and a specificity of 85 percent. Test B has a sensitivity of 92 percent and a specificity of 89 percent. Which test will be most accurate in correctly identifying patients who are infected with flu?
a. Test A, because it has higher sensitivity
b. Test A, because it has a higher predictive value negative
c. Test B, because it has higher specificity
d. Test B, because it has higher predictive value negative
What is: A. Test A, because it has higher sensitivity?
Rationale: Test A is the best choice. It will correctly identify 98 percent of people who have flu because it has 98 percent sensitivity. The specificity of Test A is 85 percent, so 15 percent of patients who do not have flu will be identified as positive (15 percent false positives [FPs]). In this case the IP is most interested in isolating infected patients, so the false-positive rate is an acceptable trade-off in this example.
While making rounds on a nursing unit, the IP encounters a nurse who has just incurred a needlestick after giving an injection to a patient. The nurse tells the IP that the patient’s recent laboratory results indicate that he has Hepatitis B, and the nurse has not completed her Hepatitis B vaccination series. She requests the IP’s advice. In reviewing the patient’s record, the IP finds that the patient’s antibody to Hepatitis B is positive and his Hepatitis B surface antigen (HBsAg) is negative. The IP’s explanation of the patient’s laboratory results indicates which of the following?
a. The patient is in the early incubation period of the disease and has a low probability of transmitting Hepatitis B; the nurse should report to Occupational Health
b. The patient had Hepatitis B in the past and does not have active disease now; the nurse should complete her Hepatitis B series as scheduled, but no additional treatment is needed
c. The results indicate a possible error in the results and another blood sample should be submitted
d. The patient does have Hepatitis B but the disease is resolving; the nurse should report to Occupational Health
What is: B. The patient had Hepatitis B in the past and does not have active disease now; the nurse should complete her Hepatitis B series as scheduled, but no additional treatment is needed?
Rationale: HBsAg is a protein on the surface of HBV; it can be detected in high levels in serum during acute or chronic HBV infection. The presence of HBsAg indicates that the person is infectious. The presence of Hepatitis B surface antibody (anti-HBs) is generally interpreted as indicating recovery and immunity from HBV infection. This patient’s surface antibody is positive and the surface antigen is negative, indicating that he is immune due to a natural infection. The nurse does not have to take any action.