Free CBIC CIC Exam Flashcards

Six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Transmission stops if ANY single link is broken, which is why interventions are chosen by the link they interrupt (sterilization removes the agent, precautions block the mode, vaccination protects the host).

Colonization is the presence and multiplication of an organism WITHOUT tissue invasion, host immune response, or clinical signs. Infection adds host injury and a clinical or immunologic response. Both can transmit, but only infection is counted as a case; treating colonization drives resistance.

An apparent cluster of positive laboratory results with NO true clinical infection, caused by contaminated specimens, contaminated reagents or scopes, lab cross-contamination, or a changed test method. The clue is positive cultures without matching signs and symptoms; investigate the laboratory and collection process, not the patients.

Sensitivity is the proportion of people WITH the disease that the test calls positive (true positive rate); a highly sensitive negative result helps rule disease OUT. Specificity is the proportion WITHOUT the disease that the test calls negative; a highly specific positive result helps rule disease IN. Both are properties of the test and do not change with prevalence.

PPV is the probability that a positive test means true disease. Unlike sensitivity and specificity, PPV depends on PREVALENCE: as prevalence falls, the same test produces more false positives and PPV drops. This is why screening a low-risk population (for example, urine cultures on asymptomatic patients) generates misleading positives.

Prophylactic is given BEFORE infection to prevent it (surgical prophylaxis). Empiric is given AFTER suspected infection but BEFORE the organism is known, based on likely pathogens. Therapeutic (definitive/targeted) is given after culture and susceptibility results identify the organism, and should be de-escalated to the narrowest effective agent.

The incubation period runs from exposure to the FIRST SYMPTOM and drives contact tracing windows and quarantine length. The communicable (infectious) period is the interval during which the host can transmit the agent, which often begins BEFORE symptoms appear and determines isolation duration. They overlap but are not the same interval.

Ordering, collecting, and reporting tests so results reflect true disease: test only when pretest probability is real, collect the specimen before antimicrobials, and reject poorly collected samples. Example: culturing urine from an asymptomatic catheterized patient finds asymptomatic bacteriuria, not CAUTI, and drives unnecessary treatment.

Incidence counts NEW cases arising in a population at risk over a defined period, so it measures risk and is the right measure for HAI surveillance. Prevalence counts ALL existing cases (new plus old) at a point or period, so it measures burden and is used for point-prevalence surveys. Prevalence roughly equals incidence times average duration.

Observed infections divided by PREDICTED infections, where the prediction is risk-adjusted from the NHSN national baseline. SIR of 1.0 means as expected, above 1.0 means more infections than predicted, below 1.0 means fewer. NHSN does not calculate an SIR when fewer than 1 infection is predicted, because the estimate would be unstable.

Verify the diagnosis and confirm an outbreak exists against BASELINE rates, notify stakeholders, write a case definition, find cases systematically, describe by person/place/time (line list and epidemic curve), form a hypothesis on source and mode, test it with an analytic study, implement and evaluate control measures, and report findings. Control measures start as soon as a plausible source appears; they do not wait for the analytic study.

A point source curve is a single sharp peak with all cases falling inside one incubation period, pointing to one common exposure. A continuous common source curve plateaus while exposure persists. A propagated curve shows successive peaks separated by roughly one incubation period, indicating person-to-person spread.

A laboratory-confirmed bloodstream infection in a patient who has had a central line in place for more than 2 consecutive calendar days, with the line present on or the day before the date of event, AND no other recognized site as the source. It is a SURVEILLANCE definition, not a clinical judgment that the line caused the infection; a bloodstream infection secondary to another site is excluded.

A urinary tract infection in a patient who has had an indwelling urinary catheter in place for more than 2 consecutive calendar days, with the catheter present on or removed the day before the date of event, PLUS a qualifying sign or symptom and a qualifying urine culture with no more than two organisms. A positive urine culture alone in an asymptomatic patient is asymptomatic bacteriuria, not CAUTI.

Infection related to an operative procedure, classified as superficial incisional, deep incisional, or organ/space by the tissue level involved. The surveillance window is 30 days after the procedure for superficial incisional SSI and 30 or 90 days for deep incisional and organ/space SSI depending on the NHSN procedure category. Post-discharge surveillance is required because most SSIs appear after the patient leaves.

A three-tier ladder built on OXYGENATION, not chest radiographs: VAC (a sustained rise in the daily minimum FiO2 or PEEP after at least 2 days of stable or improving settings), then IVAC (VAC plus abnormal temperature or white blood cell count plus a new antimicrobial), then PVAP (IVAC plus qualifying microbiology). It replaced subjective VAP surveillance in adult ventilated patients.

Applied to EVERY patient regardless of suspected or confirmed diagnosis, because infectious status is often unknown. Elements: hand hygiene, PPE selected by the exposure anticipated, respiratory hygiene and cough etiquette, safe injection practices, safe handling of contaminated equipment and surfaces, and sharps safety. Transmission-based precautions are layered ON TOP, never instead of, Standard Precautions.

For organisms spread by direct or indirect contact (MDROs, C. difficile, scabies, draining wounds). PPE is GOWN AND GLOVES donned before room entry and removed before exit; single room preferred, cohorting if unavailable; dedicated or single-use noncritical equipment. Contact Precautions do not require a mask unless splash is expected under Standard Precautions.

For large respiratory droplets that travel short distances and fall quickly (influenza, pertussis, Neisseria meningitidis, mumps). PPE is a SURGICAL MASK worn on room entry; a single room is preferred but negative pressure and a respirator are NOT required, and the door may remain open. During transport the PATIENT wears the mask.

For agents that stay suspended in small particles over distance (tuberculosis, measles, varicella, disseminated zoster). Requires a fit-tested N95 or higher respirator AND an airborne infection isolation room; the door stays closed. Susceptible staff should not enter measles or varicella rooms even wearing a respirator when immune staff are available.

Opposite airflow for opposite goals. An airborne infection isolation room is NEGATIVE pressure to keep infectious air in and protect others. A protective environment is POSITIVE pressure with HEPA-filtered supply air to keep contaminated air out and protect the patient, used for allogeneic hematopoietic stem cell transplant recipients. It is not an isolation precaution for a contagious patient.

1) Before touching a patient, 2) before a clean or aseptic procedure, 3) after body fluid exposure risk, 4) after touching a patient, 5) after touching patient surroundings. Moments 1 and 2 protect the PATIENT; moments 3, 4, and 5 protect the worker and the environment. Glove use never replaces a moment; hand hygiene is performed before donning and after removing gloves.

Alcohol rub is the preferred routine agent because it acts faster and is less drying. Switch to SOAP AND WATER when hands are visibly soiled, after caring for patients with C. difficile or norovirus, and after known or suspected exposure to Bacillus anthracis, because alcohol does not reliably kill spores or nonenveloped viruses and physical removal is needed.

Don in the order gown, mask or respirator, eye protection, gloves. Doff in the reverse order of contamination: gloves and gown first (they are the most contaminated), then eye protection, with the respirator or mask removed LAST and outside the room. Perform hand hygiene immediately after removing all PPE and any time hands become contaminated during removal.

Requires a written exposure control plan reviewed and updated AT LEAST ANNUALLY and whenever tasks change, hepatitis B vaccine offered free within 10 working days of initial assignment, engineering and work-practice controls with frontline worker input on device selection, free annual training, free post-exposure evaluation and follow-up, and a sharps injury log for employers with more than 10 employees.

HIV PEP should start as soon as possible, ideally within hours of exposure, and is taken for 28 days; it is not started weeks later. For an unvaccinated worker exposed to a hepatitis B surface antigen positive source, give hepatitis B immune globulin plus start the vaccine series, ideally within 24 hours. There is no PEP for hepatitis C; manage it with baseline and follow-up testing and early treatment.

A FIT TEST is a formal qualitative or quantitative evaluation of a specific respirator make, model, and size, required before first use and at least ANNUALLY under the OSHA respiratory protection standard, and repeated after facial changes. A USER SEAL CHECK is the quick positive and negative pressure check performed EVERY time the respirator is donned. A seal check never substitutes for a fit test.

All personnel get a BASELINE individual TB risk assessment, symptom evaluation, and a TB test (IGRA or TST, using two-step TST when a TST is used for baseline). Routine ANNUAL testing is no longer recommended for personnel without known exposure; instead facilities provide annual TB education and test after exposure or when the facility risk assessment supports it.

The RISK ASSESSMENT is the prioritization step: it weighs population served, services provided, geography, historical infection data, and regulatory requirements to rank risks. The PLAN is what follows: measurable goals, objectives, interventions, and evaluation methods derived from the top-ranked risks. A plan that is not traceable to the risk assessment cannot be defended in survey.

CMS Conditions of Participation are ENFORCEABLE federal requirements tied to Medicare and Medicaid payment. Accreditation by bodies such as The Joint Commission is voluntary but can carry deemed status for CMS. CDC and HICPAC guidelines are evidence-based RECOMMENDATIONS and are not law unless a regulator, accreditor, or state adopts them by reference.

Seven elements: hospital leadership commitment, accountability (a named physician leader), pharmacy expertise, action (interventions such as prospective audit with feedback and preauthorization), tracking, reporting, and education. Leadership commitment means dedicated resources and authority, so a stewardship program with no budgeted time is failing the first element regardless of its activity list.

Plan the change and predict results, Do it as a small-scale test, Study the data against the prediction, Act to adopt, adapt, or abandon. The purpose is rapid small-cycle learning, so an intervention rolled out house-wide at once without a test cycle is not PDSA and leaves no way to attribute the change to the intervention.

COST AVOIDANCE is money not spent because infections did not happen, calculated as infections prevented times attributable cost. It is the usual justification for infection prevention programs. COST SAVINGS is a real reduction in an existing budget line, such as switching to a cheaper disinfectant. Presenting avoidance as savings will not survive a finance review.

Adults are self-directed, bring experience that becomes a learning resource, become ready to learn when a task or role demands it, are problem-centered rather than subject-centered, and are driven mostly by internal motivation. The practical consequence: infection prevention education works better as case-based problem solving tied to the learner's own unit than as a lecture on policy.

EDUCATION transfers knowledge and is measured by attendance or a post-test. COMPETENCY VALIDATION confirms the person can actually perform the task correctly, and requires observation of a return demonstration against defined criteria. A signed attendance sheet for a hand hygiene inservice is education; direct observation of technique with feedback is validation.

QI applies known evidence to improve care in a LOCAL setting; findings are used internally and IRB review is generally not required. RESEARCH is a systematic investigation designed to produce GENERALIZABLE knowledge, requires IRB review and informed consent as applicable, and follows a protocol set in advance. Intent to generalize, not the intent to publish, is the deciding test.

Strongest to weakest: systematic reviews and meta-analyses of randomized controlled trials, then individual RCTs, then cohort studies, then case-control studies, then case series and case reports, with expert opinion weakest. A single dramatic case report is not a basis to change policy; use it to generate a hypothesis, then look for higher-level evidence or run a study.

COGNITIVE covers knowledge and reasoning (why C. difficile requires soap and water), PSYCHOMOTOR covers physical skill (correctly doffing a gown), and AFFECTIVE covers attitudes, values, and willingness to comply. Choose the evaluation method to match: a written test for cognitive, direct observation for psychomotor, and audits or surveys of behavior for affective.

NEGATIVE pressure relative to the corridor, air exhausted directly outdoors or HEPA filtered before recirculation, door kept closed, and at least 12 air changes per hour in new construction or renovation (at least 6 in existing facilities). Pressure must be MONITORED daily while the room is in use, with a smoke tube or a permanent visual monitoring device.

ACH is the number of times a room's air volume is replaced each hour, and it drives how long a room must sit empty after an airborne-precautions patient leaves. Higher ACH means faster clearance: roughly 12 ACH gives about 99.9% airborne contaminant removal in about 35 minutes, while 6 ACH needs about 69 minutes for the same removal.

A matrix that crosses the CONSTRUCTION ACTIVITY type (A through D, from inspection to major demolition) with the PATIENT RISK group (low to highest) to yield a required precaution class (I through IV). Higher classes require rigid dust barriers, negative pressure in the work zone, HEPA-filtered exhaust, and controlled worker routes. The trigger for the highest controls is invasive dust plus immunocompromised patients nearby, mainly for Aspergillus.

A written program identifying where Legionella can grow and spread in building water systems, setting control limits (temperature, disinfectant residual), monitoring them, and documenting corrective action. The industry standard is ASHRAE 188, and CMS requires healthcare facilities to have Legionella water management policies. Stagnation, tepid temperatures, and low disinfectant residual are the core risk conditions.

The time the surface must remain VISIBLY WET for the EPA-registered product's label kill claim to hold. If the product dries early, the claim is void and the surface must be re-wetted, so a wipe that evaporates in 1 minute cannot deliver a 4-minute claim. Contact time is a label-specific legal claim, not a facility preference.

Sorts devices by the RISK of the tissue they touch. CRITICAL items enter sterile tissue or the vascular system and require STERILIZATION. SEMICRITICAL items contact mucous membranes or nonintact skin and require at minimum HIGH-LEVEL DISINFECTION. NONCRITICAL items touch only intact skin and require LOW-LEVEL DISINFECTION. Intended use, not the device name, determines the class.

HIGH-LEVEL kills all microorganisms except large numbers of bacterial spores. INTERMEDIATE-LEVEL kills mycobacteria (it carries a tuberculocidal claim), vegetative bacteria, most viruses and fungi, but not spores. LOW-LEVEL kills most vegetative bacteria, some fungi and viruses, but not mycobacteria or spores. The tuberculocidal claim is the dividing line between intermediate and low.

Organic material such as blood, tissue, and lubricant physically shields microorganisms and chemically inactivates disinfectants and sterilants, so a soiled instrument cannot be sterilized no matter how long the cycle runs. Point-of-use pre-cleaning to keep soil moist is part of this step, because dried bioburden is far harder to remove.

A BIOLOGICAL INDICATOR contains live, highly resistant spores (Geobacillus stearothermophilus for steam and vaporized hydrogen peroxide; Bacillus atrophaeus for dry heat and ethylene oxide) and is the ONLY monitor that directly proves the cycle killed organisms. A CHEMICAL INDICATOR changes color to show the item was EXPOSED to the process; passing external tape proves exposure, never sterility.

A daily AIR REMOVAL and steam penetration test for dynamic-air-removal (prevacuum) sterilizers, run in an EMPTY chamber in the first cycle of the day. It detects air leaks and inadequate air removal, which would prevent steam contact. It is not a biological indicator and says nothing about lethality; gravity-displacement sterilizers do not require it.

A shortened cycle for an item needed immediately, and it does not remove any step: the item must still be cleaned and decontaminated first, and it must be transported aseptically to the point of use. IUSS should NOT be used for implantable devices except in a documented emergency, and it is never an acceptable workaround for inadequate instrument inventory or scheduling convenience.

Rules that keep a prepared field sterile: only sterile items touch sterile items, the field must stay in view and is never left unattended, anything below waist or table level is considered contaminated, the outer 1 inch of a sterile drape edge is treated as unsterile, and moisture wicking through a drape (strike-through) contaminates it. A field of uncertain sterility is treated as contaminated.