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CBIC Certified Infection Control Exam Sample Questions (Q143-Q148):
NEW QUESTION # 143
An employee is presenting to Occupational Health for clearance prior to starting work at a healthcare facility.
They have a history of having received the Bacillus Calmette-Guerin (BCG) vaccination. What is the preferred methodology for pre-work clearance?
- A. Two-step purified protein derivative-based Tuberculin skin test (TST)
- B. Referral to tuberculosis (TB) clinic
- C. Interferon-gamma release assay
- D. Initial chest radiograph
Answer: C
Explanation:
The preferred methodology for pre-work clearance in this scenario is the interferon-gamma release assay (IGRA), making option C the correct choice. This conclusion is supported by the guidelines from the Certification Board of Infection Control and Epidemiology (CBIC), which align with recommendations from the Centers for Disease Control and Prevention (CDC) for tuberculosis (TB) screening in healthcare workers.
The employee's history of receiving the Bacillus Calmette-Guerin (BCG) vaccination, a vaccine commonly used in some countries to prevent severe forms of TB, is significant because it can cause false-positive results in the traditional Tuberculin skin test (TST) due to cross-reactivity with BCG antigens (CBIC Practice Analysis, 2022, Domain I: Identification of Infectious Disease Processes, Competency 1.3 - Apply principles of epidemiology).
The IGRA, such as the QuantiFERON-TB Gold test, measures the release of interferon-gamma from T-cells in response to specific TB antigens (e.g., ESAT-6 and CFP-10) that are not present in BCG or most non- tuberculous mycobacteria. This makes it a more specific and reliable test for detecting latent TB infection (LTBI) in individuals with a history of BCG vaccination, avoiding the false positives associated with the TST.
The CDC recommends IGRA over TST for BCG-vaccinated individuals when screening for TB prior to healthcare employment (CDC Guidelines for Preventing Transmission of Mycobacterium tuberculosis, 2005, updated 2019).
Option A (referral to tuberculosis clinic) is a general action but not a specific methodology for clearance; it may follow testing if results indicate further evaluation is needed. Option B (initial chest radiograph) is used to detect active TB disease rather than latent infection and is not a primary screening method for pre-work clearance, though it may be indicated if IGRA results are positive. Option D (two-step purified protein derivative-based Tuberculin skin test) is less preferred because the BCG vaccination can lead to persistent cross-reactivity, reducing its specificity and reliability in this context. The two-step TST is typically used to establish a baseline in unvaccinated individuals with potential prior exposure, but it is not ideal for BCG- vaccinated individuals.
The IP's role includes ensuring accurate TB screening to protect both the employee and patients, aligning with CBIC's focus on preventing transmission of infectious diseases in healthcare settings (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents).
References: CBIC Practice Analysis, 2022, Domain I: Identification of Infectious Disease Processes, Competency 1.3 - Apply principles of epidemiology; Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents. CDC Guidelines for Preventing Transmission of Mycobacterium tuberculosis, 2005, updated 2019.
NEW QUESTION # 144
Which of the following is the correct collection technique to obtain a laboratory specimen for suspected pertussis?
- A. Nares culture
- B. Sputum culture
- C. Cough plate
- D. Nasopharyngeal culture
Answer: D
NEW QUESTION # 145
A hospital is experiencing an increase in vancomycin-resistant Enterococcus (VRE) infections in the hematology-oncology unit. Which of the following interventions is MOST effective in halting the spread of VRE in this high-risk setting?
- A. Conducting environmental sampling for VRE contamination weekly.
- B. Restricting the use of vancomycin for all patients in the hospital.
- C. Screening all patients on admission and placing positive patients in isolation.
- D. Implementing a hand hygiene compliance audit and feedback system.
Answer: D
Explanation:
Comprehensive and Detailed In-Depth Explanation:
Hand hygiene remains the single most effective intervention to prevent the spread of vancomycin-resistant Enterococcus (VRE) in healthcare settings. Implementing an audit and feedback system significantly improves compliance and reduces VRE transmission.
Step-by-Step Justification:
* Hand Hygiene Compliance Audit and Feedback (Best Strategy)
* Studies show that poor hand hygiene is the primary mode of VRE transmission in hospitals.
* Implementing real-time auditing with feedback ensures sustained compliance and helps identify weak areas.
* Why Other Options Are Incorrect:
* A. Screening all patients and isolating VRE-positive patients:
* While screening helps identify carriers, contact precautions alone are not sufficient without strong hand hygiene enforcement.
* B. Restricting vancomycin use:
* While antimicrobial stewardship is crucial, vancomycin use alone does not drive VRE outbreaks-poor infection control practices do.
* D. Conducting environmental sampling weekly:
* Routine sampling is not necessary; immediate terminal disinfection and improved hand hygiene are more effective.
CBIC Infection Control References:
* APIC Text, "VRE Prevention and Hand Hygiene," Chapter 11.
* APIC-JCR Workbook, "Antimicrobial Resistance and Infection Control Measures," Chapter 7.
NEW QUESTION # 146
A hospital experiencing an increase in catheter-associated urinary tract infections (CAUTI) implements a quality improvement initiative. Which of the following interventions is MOST effective in reducing CAUTI rates?
- A. Routine urine cultures for all catheterized patients every 48 hours.
- B. Using antibiotic-coated catheters in all ICU patients.
- C. Implementing nurse-driven protocols for early catheter removal.
- D. Replacing indwelling urinary catheters with condom catheters for all male patients.
Answer: C
Explanation:
* Nurse-driven catheter removal protocols have been shown to significantly reduce CAUTI rates by minimizing unnecessary catheter use.
* Routine urine cultures (A) lead to overtreatment of asymptomatic bacteriuria.
* Condom catheters (C) are helpful in certain cases but are not universally effective.
* Antibiotic-coated catheters (D) have mixed evidence regarding their effectiveness.
CBIC Infection Control References:
* APIC Text, "CAUTI Prevention Strategies," Chapter 10.
NEW QUESTION # 147
Which of the following active surveillance screening cultures would be appropriate for carbapenem-resistant Enterobacterales (previously known as carbapenem-resistant Enterobacteriaceae) (CRE)?
- A. Throat or nasopharyngeal cultures
- B. Nares or axillary cultures
- C. Rectal or peri-rectal cultures
- D. Abscess or blood cultures
Answer: C
Explanation:
Carbapenem-resistant Enterobacterales (CRE) colonization is most commonly found in the gastrointestinal (GI) tract. Therefore, rectal or peri-rectal cultures are recommended for active surveillance screening.
Why the Other Options Are Incorrect?
* B. Nares or axillary cultures - CRE is not primarily found in the nasal or axillary region; this method is more relevant for detecting MRSA.
* C. Abscess or blood cultures - While CRE may be present in clinical infections, these cultures are not used for screening asymptomatic carriers.
* D. Throat or nasopharyngeal cultures - CRE does not commonly colonize the upper respiratory tract, so these are not ideal for active screening.
CBIC Infection Control Reference
The CDC and APIC guidelines emphasize rectal or peri-rectal swabbing as the most effective active surveillance method for CRE detection.
NEW QUESTION # 148
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