CBIC CIC Questions Answers

Ventilator-associated pneumonia (VAP) is a type of healthcare-associated pneumonia that occurs in patients receiving mechanical ventilation for more than 48 hours. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes identifying risk factors for VAP in the "Prevention and Control of Infectious Diseases" domain, aligning with the Centers for Disease Control and Prevention (CDC) guidelines for preventing ventilator-associated events. The question requires identifying which factor among the options increases a patient’s risk of developing VAP, based on evidence from clinical and epidemiological data.

Option B, "Nasogastric tube," is the correct answer. The presence of a nasogastric tube is a well-documented risk factor for VAP. This tube can facilitate the aspiration of oropharyngeal secretions or gastric contents into the lower respiratory tract, bypassing natural defense mechanisms like the epiglottis. The CDC’s "Guidelines for Preventing Healthcare-Associated Pneumonia" (2004) and studies in the American Journal of Respiratory and Critical Care Medicine (e.g., Kollef et al., 2005) highlight that nasogastric tubes increase VAP risk by promoting microaspiration, especially if improperly managed or if the patient has impaired gag reflexes. This mechanical disruption of the airway’s protective barriers is a direct contributor to infection.

Option A, "Hypoxia," refers to low oxygen levels in the blood, which can be a consequence of lung conditions or VAP but is not a primary risk factor for developing it. Hypoxia may indicate underlying respiratory compromise, but it does not directly increase the likelihood of VAP unless associated with other factors (e.g., prolonged ventilation). Option C, "Acute lung disease," is a broad term that could include conditions like acute respiratory distress syndrome (ARDS), which may predispose patients to VAP due to prolonged ventilation needs. However, acute lung disease itself is not a specific risk factor; rather, it is the need for mechanical ventilation that elevates risk, making this less direct than the nasogastric tube effect. Option D, "In-line suction," involves a closed-system method for clearing respiratory secretions, which is designed to reduce VAP risk by minimizing contamination during suctioning. The CDC and evidence-based guidelines (e.g., American Thoracic Society, 2016) recommend in-line suction to prevent infection, suggesting it decreases rather than increases VAP risk.

The CBIC Practice Analysis (2022) and CDC guidelines prioritize identifying modifiable risk factors like nasogastric tubes for targeted prevention strategies (e.g., elevating the head of the bed to reduce aspiration). Option B stands out as the factor most consistently linked to increased VAP risk based on clinical evidence.

The correct answer is B, "Review microbiology laboratory reports for enteric organisms in the past week," as this is the first action the infection preventionist (IP) should perform following the alert of a sewer main break and potential contamination of the city water supply. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, a rapid assessment of existing data is a critical initial step in investigating a potential waterborne outbreak. Reviewing microbiology laboratory reports for enteric organisms (e.g., Escherichia coli, Salmonella, or Shigella) helps the IP identify any recent spikes in infections that could indicate water supply contamination, providing an evidence-based starting point for the investigation (CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.2 - Analyze surveillance data). This step leverages available hospital data to assess the scope andurgency of the situation before initiating broader actions.

Option A (notify the Emergency and Admissions departments to report diarrhea cases to infection control) is an important subsequent step to enhance surveillance, but it relies on proactive reporting and does not provide immediate evidence of an ongoing issue. Option C (contact the Employee Health department and ask for collaboration in case-finding) is valuable for involving additional resources, but it should follow the initial data review to prioritize case-finding efforts based on identified trends. Option D (review the emergency preparedness plan with engineering for sources of potable water) is a critical preparedness action, but it is more relevant once contamination is confirmed or as a preventive measure, not as the first step in assessing the current situation.

The focus on reviewing laboratory reports aligns with CBIC’s emphasis on using surveillance data to guide infection prevention responses, enabling the IP to quickly determine if the sewer main break has already impacted patient health and to escalate actions accordingly (CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.1 - Conduct surveillance for healthcare-associated infections and epidemiologically significant organisms). This approach is consistent with CDC guidelines for responding to waterborne outbreak alerts (CDC Environmental Public Health Guidelines, 2020).

Empiric antibiotic therapy is theimmediate initiation of antibioticsbased on clinical judgment before laboratory confirmation of an infection. In this case, thepresence of fever, erythema, and tenderness at the central line sitesuggests a possible bloodstream infection, prompting empiric treatment with vancomycin.

Step-by-Step Justification:

Initiation Before Lab Confirmation:

Empiric therapystarts treatment based on symptomswhile awaiting culture results​.

Prevents Complications:

Delayed treatment in central line-associated bloodstream infections (CLABSI)can lead to sepsis.

Common in High-Risk Situations:

Empiric treatment is used in caseswhere waiting for lab results could worsen the patient’s condition.

Why Other Options Are Incorrect:

B. Prophylactic:

Prophylactic antibioticsare given to prevent infection, not to treat an existing one.

C. Experimental:

Experimental treatment refers toclinical trials or unproven therapies, which does not apply here.

D. Broad spectrum:

Broad-spectrum antibiotics covermultiple bacteria, but empiric therapy may benarrow-spectrum based on suspected pathogens​.

CBIC Infection Control References:

APIC Text, Chapter on Antimicrobial Stewardship and Empiric Therapy​.

The correct answer is D, "sodium hypochlorite," as it is an effective sporicidal disinfectant for Clostridioides difficile that the infection preventionist (IP) should recommend. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, Clostridioides difficile (C. difficile) is a spore-forming bacterium responsible for significant healthcare-associated infections (HAIs), and its spores are highly resistant to many common disinfectants. Sodium hypochlorite (bleach) is recognized by the Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) as a sporicidal agent capable of inactivating C. difficile spores when used at appropriate concentrations (e.g., 1:10 dilution of household bleach) and with the recommended contact time (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.4 - Implement environmental cleaning and disinfection protocols). This makes it a preferred choice for environmental disinfection in outbreak settings or areas with known C. difficile contamination.

Option A (quaternary ammonium compound) is effective against many bacteria and viruses but lacks sufficient sporicidal activity against C. difficile spores, rendering it inadequate for this purpose. Option B (phenolic) has broad-spectrum antimicrobial properties but is not reliably sporicidal and is less effective against C. difficile spores compared to sodium hypochlorite. Option C (isopropyl alcohol) is useful for disinfecting surfaces and killing some pathogens, but it is not sporicidal and evaporates quickly, making it ineffective against C. difficile spores.

The IP’s recommendation of sodium hypochlorite aligns with CBIC’s emphasis on selecting disinfectants based on their efficacy against specific pathogens and adherence to evidence-based guidelines (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.5 - Evaluate the environment for infection risks). Proper use, including correct dilution and contact time, is critical to ensure effectiveness, and the IP should collaborate with the Product Evaluation Committee to ensure implementation aligns with safety and regulatory standards (CDC Guidelines for Environmental Infection Control in Healthcare Facilities, 2019).