CIC Exam

Requirements for sterile storage areas?

Positive pressure, 2-4 air exchanges/hr, RH = 60%, 22-26C

What is the ceramic ring test?

Used to validate the cavitation of the ultrasonic process.

What is the Bowie-Dick Test?

a daily diagnostic procedure used to verify the performance of pre-vacuum (dynamic-air-removal) steam sterilizers, such as hospital or dental autoclaves

What is an important consideration for selecting a disinfectant for vaginal probes?

Should be effective against non-enveloped viruses (ie HPV)

What temperature is needing for hot water washing of linens?

71 C for min. 25 mins

What is the growth range for legionella?

25 to 42 C

What is the threshold for institutions to implement control measures & resample for Legionella?

When 30% of more of cultures samples are positive

What are the temperature and relative humidity requirements for an OR?

20-24 c, RH: 20-60%

What MER-V rating is required in an OR?

MER-V 14 (old) —> new is MERV-16

What are some important considerations for using HP vapour treatments?

Good for terminal cleaning esp. for environmental contamination (ie c diff), reaches all surfaces incl. fabrics & walls, must be unoccupied & contained in the room

Food poisoning incubation periods?

c. perfingens: 10-12 hours, e coli: 3-8 days, salmonella: 6-48 hours, s.aureus: 30 mins - 8 hours

What type of virus is mpox?

ds DNA, enveloped, part of orthopoxvirus family

For blood cultures, what is the goal contamination rate?

< 3%

How long after exposure to Hep C do s/s develop?

2-12 weeks post exposure

What type of virus is VZV?

Herpes family, DNA virus

What is the incubation period for fungal meningitis?

3-4 weeks

CSF characteristics for bacterial meningitis?

Dec glucose, inc proteins, neutrophil predominance

Characteristics of gram negative bacteria?

Nearly red, endotoxins, lipopolysaccharide layer of cell wall, etoh wash disrupts lipo layer and crystal violet is rinsed out of cell wall, colourless until counterstain with safranin, can have flagella

Characteristics of gram pos bacteria?

purple, produces endospores, thick peptidoglycan layer that does not allow crystal violet to be removed during etoh wash, can have flagella

Progression of disease in pertussis?

1. Catarrhal: onset, runny nose, fever, mild cough that gets worse. 1-2 weeks.

2. Paroxysmal: cough becomes paroxysmal (numerous rapid coughs). Pertussis is suspected. Usually lasts 1-6 weeks, up to 10.

3. Convalescent: recovering, 2-3 weeks

What is CoNS?

• Part of normal flora

• Staph aureus is NOT one

When is TB deemed non-infectious?

• 3 negative AFBs

• 2 weeks of tx

• s/s improved

Precautions for latent TB?

None

What is the most common type of TB and so what should be done if TB is suspected?

• Pulmonary most common type

• Should have a CXR

What should be done if CXR in a suspected TB patient is abnormal?

• AFBs & cultures x 3 at least 8 hours apart

• Cultures should be done on liquid media

What is Failure Mode and Effects Analysis (FEMA)?

• Systematic method for identifying failure modes in a system

• Determining their effects

• Prioritizing actions to mitigate/elim the failures

• Facilitates sustained reductions in infections over time

• PROACTIVE

• What could go wrong

How to begin a case control study?

• begin with identifying persons who have the outcome of interest (ie disease)

• then find a control group without the outcome of interest

• control group should still have the exposure (or potential for exposure)

Process vs Outcome Surveillance

• Process: review of practices by HCWs to identify whether IPAC p&ps or best practices are being followed.

• Outcome: tracking, analyzing, and reporting results such as HAI rates.

Process Measures

• process or steps that lead to a specific outcome.

• used to evaluate compliance with desired care or to monitor variation in these practices

• examples:

  • med errors, flu vax rates, HBV immunity rates, compliance with IPAC, TST testing, MDRD, environmental cleaning, AMS, construction barriers

Outcome Measures

• Indicates the result of the performance of a function or process.

• Examples: BSIs, CAUTI, SSI, VAP, etc.

Structural Measures

• Gives consumers a sense of the HCP’s capacity, system, and processes to provide high quality care

• Ex: # of board certified MDs, pt ratios

Clinical Performance Measure

• Evaluates process or outcomes of care

• must be condition or procedure specific of address important functions in pt care

• Ex: medication use, clinical events, sentinel events

Leprosy

• Mycobacterium leprae

• AKA Hansen’s disease

• affects skin and peripheral nerves

• cardinal signs: loss of sensation in a pale/red skin patch, thickened peripheral nerve, microscopic detection of bacilli in a slit skin smear

• transmission unknown but close person to person and resp. droplets BUT for hospital settings routine practices are enough

Toxic Anterior Segment Syndrome (TASS)

• HA endophthalmitis can be non infectious or infectious

• OBs of TASS have been associated with breaches in MDRD.

Horizontal strategies to dec HAIs

• universally applied

• population based

• target all pathogens

• EX: HH, CHG bath, care bundles

Vertical strategies to dec HAIs

• target individual pathogens that are deemed important

• ++ money & resources

• Ex: universal screening of MRSA

What is the preferred access site for dialysis?

AV fistula

3 Standards of Care

1. conventional: everyday norm

2. contingency: adjustments to every day care but still functional

3. crisis: major adjustments have to be made to delivery care

What are Enhanced Barrier Precautions?

• to reduce transmission of MDROs (other than c diff)

• targeted glove and gown use during high contact resident activities for residents known or at risk of MDROs

• Risk: wounds, indwelling devices

How many air exchanges are needed for an AIIR?

6-12

VAP bundle includes (5):

1. elevate HoB

2. DAILY sedation vacation and ax readiness to extubate

3. DAILY oral care with CHG

4. PUD prophylaxis

5. DVT prophylaxis

How far from a sink can water splash? (ie how far away from sinks should care activities take place)

Water can splash 3 ft from a sink

Levels of Prevention (4):

1. Prevents onset of disease

2. Early detection, intervention to halt progression of disease

3. Managing & treating existing disease to prevent complications

4. Proactive measures to dec unnecessary medical procedures, ethically acceptable alternatives

Contact transmission: direct vs indirect

• direct: germs transferred person-to-person

  • can be vertical (mom to baby), horizontal (anything other than mom to baby), or droplet

  • ex: neonatal CMV

• indirect: germs transferred through a contaminated object

Which percentage of CJD is familial vs sporadic and what is most common age of onset?

• 85% sporadic, 15% familial

• other types are iatrogenically (healthcare acquired) or ingestion (bovine)

• 50-70 years old onset

What is Total Worker Health (TWH)?

• eliminate or reduce hazards is most effective

• through engineering, administrative, or as a last resort indiv level interventions

• emphasize elimination or control as primary goal

• addresses environmental determinants of health > focus on indiv level

What is Root Cause Analysis?

• retrospective look at adverse outcomes

• determines what happened, why, and what can be done to prevent in the future

• used for sentinel events

• REACTIVE

• Why did this happen?

For a Hep B exposed employee who is not immune, what should be done?

Should start vaccine series & receive PEP

Dengue Exposed HCW Considerations:

• HCWs can be exposed via blood in needlestick injury

• Supportive tx only

• Should only be vaxed if has been previously infected with confirmed dengue

HCW exposed to Hep C - what type of testing should the source patient have done?

HCV RNA because antibodies don’t show up for 2-3 months.

What is Just In Time Teaching

• providing instruction at the moment it is needed, usually in response to a specific problem or task.

• Immediate, task specific.

• Addressing specific, real-time learning needs.

• Ex: how to obtain a mpox swab.

Strategies to Inc HH

• HH influenced by behaviour of other HCWs

• Should use peer mentorship

How to create sustained behaviour change?

• repetition & reinforcement

What is item analysis?

examining student’s test scores in order to assess the quality of the individual test questions and the test itself.

What is social cognitive theory?

• interaction of the person, behaviour, and the environment.

• instrumental in HH compliance.

Leadership Styles

• charismatic: encourages behaviour via personality, persuasion, and communication.

What is Gap Analysis?

• most suitable process improvement tool for comparing current processes/practices with best practice guidelines

What is an important consideration for strategic goals?

should align with long term objectives

What are components of a business plan?

• formal statments of business goals, the reasons they are attainable, and the plan for reaching goals

• decision making tool and cost and revenue estimates are central to any business plan.

Who is the central decision making and policy making body for IPAC in the HC setting?

IPAC committee

What is implementation science?

• study of the methods/strategies that facilitate uptake of evidence based practice and research

• Tries to close the know-do gap (what we know and what we do)

• Involve system thinking

Pareto Chart

• Pareto chart is a type of bar graph that shows:

  • Problems or causes (e.g., infection types, errors, compliance failures)

  • Ordered from most frequent to least frequent

  • With a cumulative line showing total impact

• It is based on the 80/20 rule: About 80% of problems come from 20% of causes

• You’ll often see questions like:

  “Which tool helps prioritize the most common causes of infection?”

  “Which graph demonstrates the 80/20 principle?”

Histogram

• type of bar graph that shows the distribution of continuous data—meaning how often values fall within certain ranges.

• A histogram displays:

  • Frequency of data

  • Organized into intervals (bins)

  • The shape of the data distribution

LOS (Days)	Number of patients
0–3	5
4–7	18
8–11	12
12–15	6
16+	2

Run Chart

• basic quality improvement graph that shows data over time to help identify trends, shifts, or changes in a process.

• contains a median line

• commonly used to track HAI rates over time

• They often ask:

  “Which tool shows data over time to detect trends or shifts?”

Run chart variation

a shift is indicated by 6 or more consecutive points trending in one direction on either side of the median line.

• warrants investigation

Non parametric data

• makes no assumptions about the dist. of the population values and can be used with discrete data, nominal or ordinal, and interval data.

• main advantage: no assumption for normality required.

Correlation coefficient = r

• shows whether pairs of variables are related

• r measures degree (strength) of a relationship

• ranges between -1 to +1

• positive correlation (as x increases, y increases) or (as x decreases, y decreases)

• negative correlation (as x increases, y decreases) or (as x decreases, y increases)

Normal Distribution (1, 2, and 3 SDs from the mean)

1 SD = 68% of data

2 SD = 95% of data

3SD = 99% of data

mean, median, and mode are equal

Confidence intervals in statistical significance

• a CI that does not include the null value (such as 1 for RR/OR) provides evidence against the null hypothesis.

Odds Ratio Formula

Prevalence Formula

number of pts with disease / total population

x 100

Attack Rate Formula

number of cases/ at risk population

x 100

Attributable Risk Formula

number of exposed who got disease/ total number exposed

minus

number of unexposed who got disease/total not exposed

TST Readings

Laminar air flow

• LAF is used to supply a steady stream of clean air

  across or down a room and is used primarily in specialty type

  ORs (e.g., orthopedic surgery).

• It is designed to move particle-

  free air ("ultraclean air") over the aseptic operating field at a

  uniform speed, removing particles from its path.

Min. air exchanges per hour for OR, AIIR, Protective, Patient Rooms

• OR: 15

• AIIR: 12

• Protective: 12

• Pt Room: 4

Epi Triangle

• host, agent, environment

What is SWOT Analysis?

• a strategic planning framework used to evaluate a business, project, or personal goal.

• stands for Strengths, Weaknesses, Opportunities, and Threats.

• helps decision-makers identify competitive advantages, mitigate risks, and uncover areas for growth

What is the Plan, Do, Study, Act (PDSA) Cycle?

• a structured, four-step iterative model used for continuous quality improvement and problem-solving.

• t allows teams to test small-scale changes, evaluate the results, and refine processes based on real-world data before committing to broader implementation

What is the health belief model?

• For a behavior change to occur, the perceived threat (susceptibility × severity) and the perceived benefits must outweigh the perceived barriers

Transtheoretical Model

• aka stages of change

• precontemplation, contemplation, preparation, etc

Which infections dont have a PEP protcol?

1. Mumps

2. HCV

3. Rubella

Surfaces contaminated with blood/bopyd fluid should be disinfected with what level of disinfectant?

Intermediate

What does an antibiogram measure

• An antibiogram provides the percentage of samples for a given

organism that were sensitive to certain antibiotics and can be unit-specific or

reflect hospital-wide isolates.

Fishbone Diagram

• also called a tree diagram or Ishikawa)

• allows a team to identify, explore, and graphically display all of the possible causes

related to a problem to discover the root cause.

WBC count normal range

Leukocytosis refers to an elevated white blood cell (WBC) count,

typically exceeding the normal range of 4,000 to 10,000 cells/mm3

Budding formation and a smooth, creamy colony - which organism?

Candida

Bloom’s Taxonomy

1. Remember

2. Understand

3. Apply

4. Analyze

5. Evaluate

6. Create

RUAAEC

During disaster planning, how many litres of backup water supply per person?

10 L

How long after exposure to HIV should PEP be given?

must be started within 72 hours after a recent

possible exposure to HIV.

Endo vs Ext toxins

• Exotoxins can posess enzymatic activity and can be found in gram neg & pos bacteria

• Endotoxins are part of outer membrane of gram negatives

What is a disadvantage of quats?

Limited spectrum of activity against certain pathogens

What is the standardized infection ratio (SIR)?

• calculated by observed/expected

• The Standardized Infection Ratio (SIR) is the primary summary measure used by the NHSN to track HAIs.

• A SIR less than 1.0 indicates that fewer HAIs were observed than expected.

• If the p-value is less than 0.05 and the 95% CI does not cross the number 1, the SIR is statistically significantly different than 1

How to calculate PPV?

PPV = TP / (TP + FP)

Precautions for pneumonic plague?

Droplet

AIIR air pressure?

An airborne infection isolation room (i.e. negative pressure room)

must maintain a negative pressure differential of at least 0.01” (i.e. −0.01”).

How long do endoscope channels need to be dried after cleaning/disinfecting?

• Endoscope channels should be dried for a minimum of 10 minutes with pressure-regulated forced instrument air (or HEPA-filtered air) after completion of the cleaning and disinfection process.

• This ensures thorough drying to minimize the risk of microbial contamination and biofilm formation.

Intrinsic vs extrinsic contamination

intrinsic contamination refers to the presence of pathogens in apparatus or medicine before use. Intrinsic contamination usually occurs during the manufacturing process, whereas extrinsic contamination occurs during use

special vs common cause variation

Special cause variation is variation that lies more than three standard deviations outside the mean of the sample distribution. Common cause variation represents variation within thee standard deviations of the mean and includes 99.73% of all probably events, so special cause variation represents the remaining 0.27% of all events.

Most common infection following cat bite?

pasteurella