CIC Questions Bank

In an outbreak investigation,the first critical stepis tonotify facility administrationand other key stakeholders.This ensures the rapid mobilization of resources, coordination with infection control teams, and compliance with regulatory reporting requirements.

Why the Other Options Are Incorrect?

A. Conduct environmental cultures– Whileenvironmental sampling may be necessary, it isnot the first step. The outbreak must first be confirmed and administration alerted.

B. Plan to prevent future outbreaks–Prevention planning happens laterafter the outbreak has been investigated and controlled.

D. Perform analytical studies–Data analysis occurs after case definition and initial response measures are in place.

CBIC Infection Control Reference

APIC guidelines state thatthe first step in an outbreak investigation is confirming the outbreak and notifying key stakeholders​.

The correct answer is B, "Fishbone diagram," as this is the most appropriate quality tool for the team to use when determining what has contributed to the recent increase in catheter-associated urinary tract infections (CAUTIs). According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, the fishbone diagram, also known as an Ishikawa or cause-and-effect diagram, is a structured tool used to identify and categorize potential causes of a problem. In this case, the team needs to explore the root causes of the CAUTI increase, which could include factors such as improper catheter insertion techniques, inadequate maintenance, staff training gaps, or environmental issues (CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.2 - Analyze surveillance data). The fishbone diagram organizes these causes into categories (e.g., people, process, equipment, environment), facilitating a comprehensive analysis and guiding further investigation or intervention.

Option A (gap analysis) is useful for comparing current performance against a desired standard or benchmark, but it is more suited for identifying deficiencies in existing processes rather thanuncovering the specific causes of a recent increase. Option C (plan, do, study, act [PDSA]) is a cyclical quality improvement methodology for testing and implementing changes, which would be relevant after identifying causes and designing interventions, not as the initial tool for root cause analysis. Option D (failure mode and effect analysis [FMEA]) is a proactive risk assessment tool used to predict and mitigate potential failures in a process before they occur, making it less applicable to analyzing an existing increase in CAUTIs.

The use of a fishbone diagram aligns with CBIC’s emphasis on using data-driven tools to investigate and address healthcare-associated infections (HAIs) like CAUTIs, supporting the team’s goal of pinpointing contributory factors (CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.3 - Identify risk factors for healthcare-associated infections). This tool’s visual and collaborative nature also fosters team engagement, which is essential for effective problem-solving in infection prevention.

Glove Contamination and SSI Risk:

Failure to change contaminated gloves increases the risk of surgical site infections (SSIs)​.

Double-gloving with an outer glove change reduces contamination.

Why Other Options Are Incorrect:

B. Alcohol-based hand rubs: Are FDA-approved alternatives to traditional scrubs and effective​.

C. Delayed antibiotics: Increases infection risk, but immediate correction reduces harm.

D. Airflow disruption: Can increase SSI risk, but glove contamination poses a more direct threat.

CBIC Infection Control References:

APIC-JCR Workbook, "Surgical Infection Prevention," Chapter 6​.

10% lipid emulsionsare themost likely to promote microbial growthbecause they provide an ideal environment forbacterial and fungal proliferation, especiallyStaphylococcus aureus, Pseudomonas aeruginosa, and Candida species. Lipids supportrapid bacterial multiplicationdue to theirhigh nutrient content.

Why the Other Options Are Incorrect?

A. 50% hypertonic glucose–High glucose concentrations inhibit bacterial growthdue toosmotic pressure effects.

B. 5% dextrose– While it can support some bacterial growth, it isless favorablethan lipid emulsions.

C. Synthetic amino acids– These solutionsdo not support microbial growth as well as lipid emulsions.

CBIC Infection Control Reference

APIC guidelines confirm that lipid-based solutions support rapid microbial growthand should be handled with strict aseptic technique​.