Processes to Identify Infectious Diseases
16.5%of exam
Surveillance and Epidemiologic Investigation
20%of exam
Preventing/Controlling the Transmission of Infectious Agents
16.5%of exam
Employee/Occupational Health
8.2%of exam
Management and Communication of the Infection Prevention Program
8.2%of exam
Education and Research
7.1%of exam
Environment of Care
11.8%of exam
Cleaning, Disinfection, Sterilization of Devices
11.8%of exam
Quick Facts
- Exam
- a-IPC (CBIC)
- Items
- 100 total, 85 scored
- Pretest
- 15 unscored items
- Testing time
- 2 hours
- Appointment
- 2.5 hours total
- Pass
- 700 scaled (300-900)
- Score report
- Pass = no number
- Fee
- $335 USD
- Pass rate
- 63% (2025 testers)
- Navigation
- Forward-only, no review
- Delivery
- Prometric or ProProctor
- Eligibility
- None required
- Valid
- Five years
- Retake
- Once every six months
- Blueprint
- Effective May 2026
Chain of Infection
Agent | Reservoir | Exit | Mode | Entry | Host
Break one linkHand hygiene = modeVaccine = hostReprocessing = reservoir
Colonization vs Infection
Colonization
- Organism present
- No tissue damage
- Usually not treated
Infection
- Tissue damage
- Clinical signs present
- Counted in surveillance
Presence vs harm
Chain of Infection
- Infectious agent
- The pathogen itself
- Reservoir
- Where the agent lives
- Portal of exit
- How it leaves
- Mode of transmission
- How it travels
- Portal of entry
- How it enters
- Susceptible host
- Who it infects
- Break any link
- Transmission stopsRule
- Hand hygiene breaks
- Mode of transmission
- Vaccination breaks
- Susceptible host
Prophylactic vs Empiric
Prophylactic
- Before infection exists
- Preoperative dosing
- Prevention goal
Empiric
- Infection suspected
- Cultures pending
- Guided by antibiogram
Prevent vs treat blind
Infection Status Terms
- Colonization
- Present, no tissue damage
- Infection
- Damage plus clinical response
- Contamination
- Organism on surface/specimen
- Pseudo-infection
- False positive, no disease
- Pseudo-outbreak
- Cluster of pseudo-infections
- Incubation period
- Exposure to symptom onset
- Communicable period
- When spread is possible
- Only infections count
- Colonization is excludedTrap
Lab and Diagnostic Signals
- Gram stain
- Minutes, presumptive only
- Culture + AST
- Days, gives susceptibility
- MALDI-TOF
- Rapid organism identification
- Multiplex PCR
- Hours, detects nucleic acid
- Whole genome sequencing
- Confirms outbreak relatedness
- Antibiogram
- Facility susceptibility summary
- Leukocytosis + left shift
- Suggests bacterial infection
- Fever threshold
- NHSN uses >38.0°C
- Read susceptibility panel
- Not organism name alone
Antimicrobial Use Categories
- Prophylactic
- Given before infection occurs
- Empiric
- Before cultures return
- Therapeutic/definitive
- Organism and susceptibility known
- Surgical prophylaxis timing
- Within 60 min before incision
- Vancomycin/fluoroquinolone window
- 120 minutes before incision
- After wound closure
- No additional doses
- De-escalation
- Narrow after culture results
Host Risk Factors
- Extremes of age
- Neonates and elderly
- Neutropenia
- Low neutrophil defense
- Transplant/chemotherapy
- Drug-induced immunosuppression
- Chronic corticosteroids
- Blunted inflammatory response
- Indwelling devices
- Bypass skin barrier
- Recent surgery
- Breached tissue planes
- Prior antimicrobials
- Selects resistant flora
- Travel + exposure history
- Shapes plausible pathogens
Alert Organisms
- MRSA
- Methicillin-resistant Staphylococcus aureus
- VRE
- Vancomycin-resistant Enterococcus
- CRE
- Carbapenem-resistant Enterobacterales
- C. difficile
- Spore-forming, toxin-mediated colitis
- Candida auris
- Multidrug-resistant, environmentally persistent yeast
- M. tuberculosis
- Airborne, requires AIIR
- Legionella pneumophila
- Water system pathogen
- Aspergillus fumigatus
- Construction dust mold
- Norovirus
- Alcohol-resistant, explosive gastroenteritis
Outbreak Order
Verify | Define | Find | Describe | Hypothesize | Control | Report
Control can start earlyDefinition before case findingTime, place, person
Incidence vs Prevalence
Incidence
- New cases only
- Measures risk
- Needs a period
Prevalence
- New plus existing
- Measures burden
- Point in time
Risk vs burden
Rate Picker
- New cases over period→Incidence
- All cases at once→Prevalence
- Outbreak among exposed→Attack rate(Times 100)
- Comparing device infections→Rate per 1,000 device-days
- Comparing surgical infections→Rate per 100 procedures
- Measuring device exposure→Device utilization ratio
- Comparing to national baseline→SIR(Risk-adjusted)
- Predicted below 1.0→Rates instead(No SIR calculated)
Epidemiology Formulas
- Incidence
- New cases / population at risk
- Prevalence
- All cases / population, point
- Attack rate
- Ill / at risk x 100
- Device-associated rate
- Infections / device-days x 1,000
- SSI rate
- SSIs / procedures x 100
- DUR
- Device-days / patient-days
- SIR
- Observed / predicted infections
- SUR
- Observed / predicted device-days
- SIR floor rule
- Not calculated below 1.0 predictedNHSN
- SIR under 1.0
- Fewer infections than predicted
Rate vs SIR
Rate
- Per 1,000 device-days
- Not risk-adjusted
- Good for trending
SIR
- Observed / predicted
- Risk-adjusted
- Needs 1.0 predicted
Local trend vs benchmark
Test Accuracy Metrics
- Sensitivity
- TP / (TP + FN)
- Specificity
- TN / (TN + FP)
- PPV
- TP / (TP + FP)
- NPV
- TN / (TN + FN)
- Sensitivity finds cases
- Few missed infections
- PPV depends on prevalence
- Falls in low-prevalence populationsTrap
- Mean, median, mode
- Measures of central tendency
- Standard deviation
- Spread around the mean
Sensitivity vs PPV
Sensitivity
- TP / (TP + FN)
- Property of the test
- Prevalence independent
PPV
- TP / (TP + FP)
- Depends on prevalence
- Answers: is it real
Test property vs result meaning
NHSN HAI Definitions
- CLABSI line rule
- In place >2 consecutive days
- CLABSI eligibility starts
- Central line day 3
- Central line
- Ends at/near the heart
- CAUTI catheter rule
- IUC >2 consecutive days
- CAUTI removal rule
- In place or removed yesterday
- CAUTI culture threshold
- 100,000 CFU/ml, max 2 species
- SSI default window
- 30 days post-procedure
- SSI 90-day list
- Implant-heavy procedure categories
- Superficial incisional SSI
- Always 30 days
- VAC baseline
- >=2 days stable oxygenation
- VAC worsening
- PEEP +3 or FiO2 +20
- Secondary BSI
- Not counted as CLABSI
SSI 90-Day Categories
- BRST
- Breast surgery
- CARD / CBGB / CBGC
- Cardiac and bypass procedures
- CRAN
- Craniotomy
- FUSN
- Spinal fusion
- FX
- Open fracture reduction
- HER
- Herniorrhaphy
- HPRO / KPRO
- Hip and knee prosthesis
- PACE
- Pacemaker surgery
- PVBY
- Peripheral vascular bypass
- VSHN
- Ventricular shunt
Outbreak Investigation Steps
- Verify the diagnosis
- Confirm laboratory results first
- Confirm the outbreak
- Compare against baseline rate
- Notify stakeholders
- Leadership, providers, public health
- Write case definition
- Clinical criteria plus time/place/person
- Conduct case finding
- Apply definition uniformly
- Describe by epidemiology
- Time, place, and person
- Form hypothesis
- Source and transmission mode
- Implement control measures
- Do not waitPriority
- Test hypothesis
- Case-control or cohort study
- Evaluate and report
- Confirm rates returned to baseline
Epidemic Curve Patterns
- Point source
- One sharp peak
- Continuous common source
- Plateau while exposure persists
- Intermittent common source
- Irregular repeated peaks
- Propagated
- Successive person-to-person peaks
- Peak spacing
- Roughly one incubation period
- X axis
- Onset date or time
- Y axis
- Number of cases
Surveillance Design Terms
- Targeted surveillance
- Selected units or procedures
- Housewide surveillance
- Whole facility, resource heavy
- Process measure
- Was the practice done
- Outcome measure
- Did infection occur
- Numerator
- Cases meeting the definition
- Denominator
- Population or device-days
- Risk assessment
- Drives the annual plan
- Validation
- Re-review records for accuracy
- Benchmark rule
- Same definitions and risk adjustment
WHO 5 Moments
Before patient | Before aseptic | After fluids | After patient | After surroundings
1 and 2 protect patient3, 4, 5 protect workerApplies to gloves too
Standard vs Transmission-Based
Standard
- All patients always
- Diagnosis irrelevant
- PPE by task
Transmission-Based
- Known or suspected pathogen
- Added on top
- Contact, droplet, airborne
Universal vs pathogen-specific
Precaution Picker
- Every patient, always→Standard Precautions(Baseline)
- Pulmonary tuberculosis→Airborne(AIIR plus N95)
- Measles or varicella→Airborne(Immune staff preferred)
- Suspected disseminated zoster→Airborne plus contact
- Influenza or pertussis→Droplet(Surgical mask)
- Neisseria meningitidis→Droplet(Until 24 hours therapy)
- MRSA, VRE, CRE→Contact(Gown and gloves)
- C. difficile→Contact(Soap, sporicidal cleaning)
- Candida auris→Contact(EPA List P)
- RSV or rotavirus→Contact(Pediatric units)
- Severely immunocompromised transplant→Protective environment(Positive pressure)
Standard Precautions
- Applies to
- Every patient, every timeRule
- Hand hygiene
- Core component
- PPE by task
- Anticipated exposure decides
- Respiratory hygiene
- Cough etiquette, source masking
- Safe injection practices
- One needle, one syringe
- Safe equipment handling
- Clean between patients
- Sharps safety
- No recapping, use containers
- Environmental cleaning
- High-touch surfaces prioritized
- Lumbar puncture mask
- Worn for spinal procedures
Contact vs Droplet
Contact
- Gown and gloves
- Touch transmission
- MRSA, VRE, C. difficile
Droplet
- Surgical mask
- Large respiratory particles
- 3-foot separation
Touch vs respiratory spray
Hand Hygiene Picker
- Hands visibly soiled→Soap and water
- C. difficile care→Soap and water(Spores survive alcohol)
- Norovirus care→Soap and water
- After restroom use→Soap and water
- Hands not soiled→Alcohol-based hand rub(Preferred default)
- Before aseptic procedure→Alcohol-based hand rub
- Before surgery→Surgical hand antisepsis
Transmission-Based Precautions
- Layered on
- Always added to Standard
- Contact PPE
- Gown and gloves
- Contact examples
- MRSA, VRE, C. difficile
- Droplet PPE
- Surgical mask on entry
- Droplet separation
- At least 3 feet
- Droplet examples
- Influenza, pertussis, meningococcus
- Airborne PPE
- N95 or higher respirator
- Airborne examples
- TB, measles, varicella
- Patient transport
- Mask the patient, notify receiver
- Cohorting
- Same organism, shared room
Alcohol Rub vs Soap
Alcohol rub
- Faster and preferred
- Kinder to skin
- No sporicidal activity
Soap and water
- Visibly soiled hands
- C. difficile, norovirus
- Physically removes spores
Kill vs physical removal
Hand Hygiene Rules
- Alcohol rub is default
- Faster, better skin tolerance
- Alcohol concentration
- At least 60% alcohol
- Soap and water when
- Hands visibly soiled
- Also soap and water
- C. difficile and norovirus
- Also after restroom
- And before eating
- Wash duration
- At least 15 seconds
- Alcohol fails against
- Bacterial spores
- Best compliance measure
- Direct observation
- Artificial nails
- Prohibited in high-risk care
Safe Injection Practices
- One needle, one syringe
- One patient, one time
- Syringe reuse
- Never, even with new needle
- Single-dose vial
- One patient only
- Multi-dose vial
- Disinfect septum every entry
- Preparation area
- Clean, away from contamination
- Bags and tubing
- One patient, then discard
- Point-of-care devices
- Dedicate or disinfect glucometers
Antimicrobial Stewardship
- Leadership commitment
- Dedicated funding and staffing
- Accountability
- Named program leader
- Pharmacy expertise
- Pharmacist co-leader
- Action
- Prospective audit and feedback
- Tracking
- Use and resistance data
- Reporting
- Share with prescribers
- Education
- Teach clinicians and patients
- Preauthorization
- Approval before restricted agent
- Antibiotic time-out
- Reassess at 48-72 hours
- IV to oral
- Convert when tolerating enterally
Emergency Preparedness
- Mitigation
- Reduce risk before events
- Preparedness
- Plan, train, stockpile
- Response
- Execute during the event
- Recovery
- Restore normal operations
- Syndromic surveillance
- Symptom patterns before diagnosis
- Surge PPE planning
- Burn rate and reserves
- Category A agents
- Anthrax, plague, smallpox, tularemia
Bloodborne Exposure Facts
- Hepatitis B risk
- 22-31% if HBeAg-positive
- Hepatitis C risk
- About 0.2% percutaneous
- HIV risk
- About 0.3% percutaneous
- Only vaccine-preventable
- Hepatitis BTrap
- First action
- Wash site, report immediately
- HIV PEP timing
- Start within hours
- HIV PEP duration
- 28 days
- HBV post-exposure
- HBIG plus vaccine, status-driven
- HCV post-exposure
- No PEP, test and treat
OSHA Requirements
- Bloodborne standard
- 29 CFR 1910.1030
- Exposure control plan
- Written, reviewed annually
- Hepatitis B vaccine
- Free, within 10 working days
- PPE cost
- Employer pays, always
- Sharps injury log
- Required record of injuries
- Engineering controls
- Safety devices, sharps containers
- Respiratory standard
- 29 CFR 1910.134
- Fit test frequency
- Before use, then annually
- Seal check
- Every single donning
- Facial hair
- Invalidates a tight seal
Personnel Health Screening
- Core HCP vaccines
- HepB, MMR, varicella, Tdap, influenza
- HBV response check
- Anti-HBs 1-2 months after
- Non-responder
- Repeat series, then evaluate
- TB baseline
- Screening on hire
- Work restriction driver
- Transmission risk to patients
- Exposed susceptible staff
- May need furlough
- Product sensitivity
- Offer latex-free alternatives
Blueprint Weights
Surveillance 20 is the biggest slice
Identify + transmission = 16.5 eachEnvironment + devices = 11.8 eachEducation 7.1 smallest
Quality Improvement Tools
- PDSA
- Plan, Do, Study, Act
- Fishbone diagram
- Groups possible causes
- Pareto chart
- Ranks the vital few
- Flow chart
- Maps the actual process
- SWOT
- Strengths, weaknesses, opportunities, threats
- Gap analysis
- Current versus required practice
- Root cause analysis
- Retrospective, after sentinel event
- Run chart
- Data plotted over time
Program Governance
- Annual risk assessment
- Foundation of the plan
- Risk ranking
- Probability times potential impact
- IP plan contents
- Goals, surveillance priorities, resources
- Chain of command
- Read the organizational chart
- Media inquiries
- Route to communications leadership
- Notifiable disease authority
- State or local, not CDC
- Urgent reporting
- Some conditions within 24 hours
- Business case
- Cost of infections avoided
- Accreditation
- Joint Commission, CMS conditions
Blueprint Item Counts
- Identify diseases
- 14 items (16.5%)
- Surveillance + investigation
- 17 items (20%)
- Preventing transmission
- 14 items (16.5%)
- Occupational health
- 7 items (8.2%)
- Management + communication
- 7 items (8.2%)
- Education + research
- 6 items (7.1%)
- Environment of care
- 10 items (11.8%)
- Device reprocessing
- 10 items (11.8%)
- Scored total
- 85 itemsSum
- CBIC publishes
- Item counts, not percentages
PDSA Cycle
Plan | Do | Study | Act
Small rapid testsPredict before you doAdopt, adapt, abandon
Adult Learning + Evaluation
- Adults learn best
- Job-relevant and immediately applicable
- Build on experience
- Respect existing knowledge
- Return demonstration
- Best proof of skill
- Teach-back
- For patients and families
- Attendance is not learning
- Measure behavior insteadTrap
- Process measure
- Observed compliance rates
- Outcome measure
- Infection rates over time
- Immediate feedback
- Correct lapses privately, now
Evidence Hierarchy
- Systematic review
- Highest, synthesizes trials
- Randomized controlled trial
- Strongest single study
- Cohort study
- Follows exposed and unexposed
- Case-control study
- Starts from outcome backwards
- Case series/report
- Descriptive, no comparison group
- Expert opinion
- Lowest level of evidence
- Check publication date
- Guidelines are superseded
- Peer review
- Preferred over vendor literature
AIIR vs Protective Environment
AIIR
- Negative pressure
- Protects others
- TB, measles, varicella
Protective environment
- Positive pressure
- Protects the patient
- HEPA supply air
Contain vs shield
Disinfectant Picker
- C. difficile room→EPA List K(Sporicidal)
- Candida auris room→EPA List P
- Norovirus outbreak→EPA List G
- Routine MRSA room→Hospital-grade disinfectant
- Blood spill present→Clean, then tuberculocidal product
- Surface still soiled→Clean before disinfecting
Environmental Cleaning
- Clean before disinfect
- Soil inactivates disinfectantsRule
- Wet contact time
- Follow the product label
- Surface dries early
- Reapply the disinfectant
- Clean to dirty
- Directional workflow
- High to low
- Work downward in room
- High-touch surfaces
- Rails, buttons, doorknobs, tables
- Terminal cleaning
- After discharge or transfer
- Cleaning verification
- ATP, fluorescent marker, culture
Cleaning vs Disinfection
Cleaning
- Physically removes soil
- Always comes first
- Mechanical action
Disinfection
- Kills remaining organisms
- Needs wet contact time
- Inactivated by soil
Remove then kill
EPA Product Lists
- List K
- Sporicidal, C. difficile
- List P
- Candida auris
- List G
- Norovirus
- List N
- SARS-CoV-2
- Quats
- Low-level, not sporicidal
- Sodium hypochlorite
- Common sporicidal choice
- Sporicidal contact times
- Usually longer than routine
Air and Water Systems
- AIIR pressure
- Negative, at least 2.5 Pa
- AIIR in inches
- 0.01 inch water gauge
- AIIR air changes
- 12 new, 6 existing
- AIIR exhaust
- Outdoors or HEPA-filtered
- AIIR door
- Kept closed, monitored daily
- Protective environment
- Positive pressure, HEPA supply
- PE air changes
- At least 12 hourly
- PE patients
- Allogeneic stem cell transplant
- Legionella program
- ASHRAE 188, CMS required
- Legionella growth drivers
- Stagnation, biofilm, scale, temperature
- Legionella growth range
- 77-113°F (25-45°C)
- Hot water storage
- At least 140°F (60°C)
ICRA and Construction
- ICRA inputs
- Activity type plus patient risk
- Done when
- Before work beginsTiming
- Primary hazard
- Aspergillus in construction dust
- Highest-risk patients
- Neutropenic and transplant recipients
- Rigid barriers
- Required for Class III/IV
- Work zone pressure
- Negative to patient areas
- HEPA exhaust
- Filters construction air
- Tacky mats
- Capture dust at exit
- Daily monitoring
- Verify barriers and pressure
Waste and Linen
- Regulated medical waste
- Would release blood if compressed
- Also regulated
- Caked dried blood
- Always regulated
- Sharps, pathological, microbiological waste
- Most room trash
- Not regulated wasteTrap
- Soiled linen handling
- Minimal agitation, bag at use
- Clean linen
- Covered transport and storage
- Sharps containers
- Puncture-resistant, closable, upright
Spaulding Ladder
Sterile tissue | Mucous membrane | Intact skin
Critical = sterilizeSemicritical = high-levelNoncritical = low-levelUse decides, not name
HLD vs Sterilization
High-level disinfection
- Kills all but spores
- Semicritical items
- Liquid chemical, timed
Sterilization
- Kills spores too
- Critical items
- Steam, EtO, plasma
Mucous membranes vs sterile tissue
Reprocessing Picker
- Enters sterile tissue→Sterilization(Critical item)
- Enters vascular system→Sterilization(Critical item)
- Touches mucous membranes→High-level disinfection(Semicritical)
- Touches non-intact skin→High-level disinfection(Semicritical)
- Touches intact skin only→Low-level disinfection(Noncritical)
- Heat-sensitive critical device→Low-temperature sterilization(EtO or plasma)
- Instrument still soiled→Clean again first(Never skip)
- Manufacturer conflicts with policy→Follow the IFU
Spaulding Classification
- Critical
- Enters sterile tissue/vascular system
- Critical requires
- Sterilization
- Semicritical
- Contacts mucous membranes
- Semicritical requires
- High-level disinfection minimum
- Noncritical
- Touches intact skin only
- Noncritical requires
- Low-level disinfection
- Category driver
- Intended use, not nameRule
- Examples critical
- Implants, surgical instruments, catheters
- Examples semicritical
- Endoscopes, laryngoscope blades
Monitoring Triad
Physical | Chemical | Biological
Physical = gaugesChemical = exposureBiological = kill proof
Chemical vs Biological Indicator
Chemical indicator
- Proves exposure only
- Every package
- Read immediately
Biological indicator
- Proves spore kill
- Weekly plus implants
- Requires incubation
Exposed vs actually killed
Disinfection Levels
- Sterilization
- Destroys all microbes, spores included
- High-level
- All except many spores
- Intermediate-level
- Kills mycobacteria, tuberculocidal claim
- Low-level
- Vegetative bacteria, enveloped viruses
- OPA 0.55%
- 12 minutes at 20°C
- Glutaraldehyde 2%
- 20 minutes at 20°C
- Other HLD agents
- Follow FDA-cleared label
- Alcohol limitation
- Not sporicidal, evaporates fast
Sterilization Parameters
- Gravity displacement
- 121°C for 30 minutes
- Prevacuum wrapped
- 132°C for 4 minutes
- IUSS unwrapped
- 132°C for 3 minutes
- Four steam requirements
- Time, temperature, steam, contact
- Air is the enemy
- Blocks steam penetration
- Ethylene oxide
- Heat-sensitive devices, long aeration
- Hydrogen peroxide plasma
- Low temperature, no cellulose
- Dry heat
- Oils, powders, anhydrous materials
- IUSS restriction
- Not routine; avoid implants
Sterilizer Monitoring
- Physical monitors
- Gauges, printouts, cycle charts
- Chemical indicator
- Shows exposure, not sterilityTrap
- Internal CI
- Inside every package
- External CI
- When internal is hidden
- Biological indicator
- Only true kill proof
- Steam and plasma BI
- Geobacillus stearothermophilus
- EtO and dry heat
- Bacillus atrophaeus
- BI frequency
- At least weekly, daily preferred
- Implant loads
- Every load, hold until negative
- Bowie-Dick test
- Daily, empty prevacuum chamber
- Bowie-Dick timing
- Before first processed load
- Positive BI
- Quarantine sterilizer, recall loads
Reprocessing Workflow
- Point-of-use treatment
- Keep soil moist
- Transport
- Closed, leak-proof container
- Clean
- The step everything depends on
- Rinse and dry
- Before disinfection or packaging
- Inspect
- Check function and residual soil
- Package and sterilize
- Or high-level disinfect
- Storage
- Controlled, dry, event-related sterility
- Workflow direction
- Dirty to clean to sterile
- Biofilm
- Defeats sterilization if left
- IFU
- Manufacturer instructions govern
Common Traps
Colonization vs infection
Colonization is not counted ≠ Infection meets surveillance criteria
Incidence vs prevalence
Incidence counts new cases ≠ Prevalence counts all cases
Alcohol rub vs spores
Alcohol kills vegetative bacteria ≠ Soap removes C. difficile spores
Chemical vs biological indicator
Chemical proves exposure only ≠ Biological proves spores died
Cleaning vs disinfection
Cleaning removes the soil ≠ Disinfection kills what remains
Device name vs use
Spaulding follows intended use ≠ Not the device label
Rate vs SIR
Rates are not risk-adjusted ≠ SIR compares to prediction
AIIR vs protective environment
AIIR is negative pressure ≠ PE is positive pressure
Total vs scored items
Exam has 100 items ≠ Only 85 are scored
Attendance vs learning
Sign-in sheets prove attendance ≠ Observation proves behavior change
Regulated vs routine waste
Most room trash is routine ≠ Saturated, sharps, pathological only
Reporting authority
States set notifiable lists ≠ CDC does not mandate
Last Minute
- 1.100 items, only 85 scored
- 2.Pass = 700 scaled; range 300-900
- 3.Passing candidates get no number
- 4.Forward-only: no skipping, no going back
- 5.Surveillance 20% is the heaviest area
- 6.Chain of infection has six links
- 7.Standard Precautions = every patient always
- 8.Airborne = N95 + negative-pressure room
- 9.Droplet = surgical mask, 3 feet
- 10.Contact = gown + gloves on entry
- 11.C. difficile = soap + EPA List K
- 12.Candida auris = EPA List P
- 13.Device rate = infections / device-days x 1,000
- 14.Attack rate = ill / at-risk x 100
- 15.SIR = observed / predicted infections
- 16.No SIR when predicted below 1.0
- 17.CLABSI and CAUTI: line >2 days
- 18.SSI = 30 days; some 90
- 19.Critical = sterilize; semicritical = high-level
- 20.Gravity = 121°C for 30 min
- 21.Prevacuum = 132°C for 4 min
- 22.Biological indicator = only kill proof
- 23.Bowie-Dick daily in empty chamber
- 24.Clean first; disinfectants need wet time
- 25.HepB vaccine within 10 working days
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