Infection Control Changed CIC Questions

The correct answer is D, "Cost benefit analysis and safety considerations," as this provides the best information to support the selection of a new catheter aimed at decreasing the rate of catheter-associated urinary tract infections (CAUTIs). According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, selecting medical devices like catheters for infection prevention involves a comprehensive evaluation that balances efficacy, safety, and economic impact. A cost-benefit analysis assesses the financial implications (e.g., reduced infection rates leading to lower treatment costs) against the cost of the new catheter, while safety considerations ensure the device minimizes patient risk, such as reducing biofilm formation or irritation that contributes to CAUTIs (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment). This dual focus provides evidence-based data to justify the catheter’s adoption, aligning with the goal of improving patient outcomes and reducing healthcare-associated infections (HAIs).

Option A (staff member preference and product availability) is subjective and logistical rather than evidence-based, making it insufficient for a decision that impacts infection rates. Option B (product materials and vendor information) offers technical details but lacks the broader context of efficacy and cost-effectiveness needed for a comprehensive evaluation. Option C (value analysis and information provided by the manufacturer) includes a structured assessment of value, but it may be biased toward the manufacturer’s claims and lacks the independent safety and cost-benefit perspective critical for infection prevention decisions.

The emphasis on cost-benefit analysis and safety considerations reflects CBIC’s priority on using data-driven and patient-centered approaches to select interventions that enhance infection control (CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.5 - Use data to guide infection prevention and control strategies). This approach ensures the catheter’s selection is supported by robust evidence, optimizing both clinical and economic outcomes in the prevention of CAUTIs.

References: CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.5 - Use data to guide infection prevention and control strategies; Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment.

An effective respiratory hygiene program in healthcare facilities aims to reduce the transmission of respiratory pathogens, such as influenza, COVID-19, and other droplet- or airborne infectious agents, by promoting practices that minimize the spread from infected individuals. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the importance of such programs within the "Prevention and Control of Infectious Diseases" domain, aligning with guidelines from the Centers for Disease Control and Prevention (CDC). The CDC’s "Guideline for Isolation Precautions" (2007) and its respiratory hygiene/cough etiquette recommendations outline key components, including source control, education, and environmental measures to protect patients, visitors, and healthcare workers.

Option B, "Mask availability at building entrance and reception," is a core element of an effective respiratory hygiene program. Providing masks at entry points ensures that symptomatic individuals can cover their mouth and nose, reducing the dispersal of respiratory droplets. This practice, often referred to as source control, is a primary strategy to interrupt transmission, especially in high-traffic areas like entrances and receptions. The CDC recommends that healthcare facilities offer masks or tissues and no-touch receptacles for disposal as part of respiratory hygiene, making this a practical and essential inclusion.

Option A, "Community educational brochures campaign," is a valuable adjunct to raise awareness among the public about respiratory hygiene (e.g., covering coughs, hand washing). However, it is an external strategy rather than a direct component of the facility’s internal program, which focuses on immediate action within the healthcare setting. Option C, "Separate entrance for symptomatic patients and visitors," can enhance infection control by segregating potentially infectious individuals, but it is not a universal requirement and depends on facility resources and design. The CDC suggests this as an optional measure during outbreaks, not a standard element of every respiratory hygiene program. Option D, "Temperature monitoring devices at clinical unit entrance," is a useful screening tool to identify febrile individuals, which may indicate infection. However, it is a surveillance measure rather than a core hygiene practice, and its effectiveness is limited without accompanying interventions like masking.

The CBIC Practice Analysis (2022) and CDC guidelines prioritize actionable, facility-based interventions like mask provision to mitigate transmission risks. The availability of masks at key entry points directly supports the goal of respiratory hygiene by enabling immediate source control, making Option B the most appropriate answer.

References:

CBIC Practice Analysis, 2022.

CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.

The scenario describes an outbreak of Aspergillus infections among three patients on an oncology unit following recent renovations, with the infections suspected to be facility-acquired. Aspergillus is a mold commonly associated with environmental sources, particularly airborne spores, and its presence in immunocompromised patients (e.g., oncology patients) poses a significant risk. The infection preventionist must identify the appropriate environmental microbiological monitoring strategy, guided by the Certification Board of Infection Control and Epidemiology (CBIC) and CDC recommendations. Let’s evaluate each option:

A. Air: Aspergillus species are ubiquitous molds that thrive in soil, decaying vegetation, and construction dust, and they are primarily transmitted via airborne spores. Renovations can disturb these spores, leading to aerosolization and inhalation by vulnerable patients. Culturing the air using methods such as settle plates, air samplers, or high-efficiency particulate air (HEPA) filtration monitoring is a standard practice to detect Aspergillus during construction or post-renovation in healthcare settings, especially oncology units where patients are at high risk for invasive aspergillosis. This aligns with CBIC’s emphasis on environmental monitoring for airborne pathogens, making it the most appropriate choice.

B. Ice: Ice can be a source of contamination with bacteria (e.g., Pseudomonas, Legionella) or other pathogens if improperly handled or stored, but it is not a typical reservoir for Aspergillus, which is a mold requiring organic material and moisture for growth. While ice safety is important in infection control, culturing ice is irrelevant to an Aspergillus outbreak linked to renovations and is not a priority in this context.

C. Carpet: Carpets can harbor dust, mold, and other microorganisms, especially in high-traffic or poorly maintained areas. Aspergillus spores could theoretically settle in carpet during renovations, but carpets are not a primary source of airborne transmission unless disturbed (e.g., vacuuming). Culturing carpet might be a secondary step if air sampling indicates widespread contamination, but it is less direct and less commonly recommended as the initial monitoring site compared to air sampling.

D. Aerators: Aerators (e.g., faucet aerators) can harbor waterborne pathogens like Pseudomonas or Legionella due to biofilm formation, but Aspergillus is not typically associated with water systems unless there is significant organic contamination or aerosolization from water sources (e.g., cooling towers). Culturing aerators is relevant for waterborne outbreaks, not for an Aspergillus outbreak linked to renovations, making this option inappropriate.

The best answer is A, culturing the air, as Aspergillus is an airborne pathogen, and renovations are a known risk factor for spore dispersal in healthcare settings. This monitoring strategy allows the infection preventionist to confirm the source, assess the extent of contamination, and implement control measures (e.g., enhanced filtration, construction barriers) to protect patients. This is consistent with CBIC and CDC guidelines for managing fungal outbreaks in high-risk units.

References:

CBIC Infection Prevention and Control (IPC) Core Competency Model (updated 2023), Domain IV: Environment of Care, which recommends air sampling for Aspergillus during construction-related outbreaks.

CBIC Examination Content Outline, Domain III: Prevention and Control of Infectious Diseases, which includes environmental monitoring for facility-acquired infections.

CDC Guidelines for Environmental Infection Control in Healthcare Facilities (2022), which advocate air culturing to detect Aspergillus post-renovation in immunocompromised patient areas.

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is an airborne disease that poses a significant risk in healthcare settings, particularly through exposure to infectious droplets. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the "Prevention and Control of Infectious Diseases" domain, which includes developing exposure control plans, aligning with the Centers for Disease Control and Prevention (CDC) "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Settings" (2005). The question seeks the most important aspect of an exposure control plan to prevent TB exposure, requiring a prioritization of preventive strategies.

Option B, "Identification of a potentially infectious patient," is the most important aspect. Early identification of individuals with suspected or confirmed TB (e.g., through symptom screening like persistent cough, fever, or weight loss, or diagnostic tests like chest X-rays and sputum smears) allows for timely isolation and treatment, preventing further transmission. The CDC guidelines stress that the first step in an exposure control plan is to recognize patients with signs or risk factors for infectious TB, as unrecognized cases are the primary source of healthcare worker and patient exposures. The Occupational Safety and Health Administration (OSHA) also mandates risk assessment and early detection as foundational to TB control plans.

Option A, "Placement of the patient in an airborne infection isolation room," is a critical control measure once a potentially infectious patient is identified. Airborne infection isolation rooms (AIIRs) with negative pressure ventilation reduce the spread of infectious droplets, as recommended by the CDC. However, this step depends on prior identification; placing a patient in an AIIR without knowing their infectious status is inefficient and not the initial priority. Option C, "Prompt initiation of chemotherapeutic agents," is essential for treating active TB and reducing infectiousness, typically within days of effective therapy, per CDC guidelines. However, this follows identification and diagnosis (e.g., via acid-fast bacilli smear or culture), making it a secondary action rather than the most important preventive aspect. Option D, "Use of personal protective equipment," such as N95 respirators, is a key protective measure for healthcare workers once an infectious patient is identified, as outlined by the CDC and OSHA. However, PPE is a reactive measure that mitigates exposure after identification and isolation, not the foundational step to prevent it.

The CBIC Practice Analysis (2022) and CDC guidelines prioritize early identification as the cornerstone of TB exposure prevention, enabling all subsequent interventions. Option B ensures that the exposure control plan addresses the source of transmission at its outset, making it the most important aspect.

References:

CBIC Practice Analysis, 2022.

CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Settings, 2005.

OSHA Respiratory Protection Standard, 29 CFR 1910.134.