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CBIC Certified Infection Control Exam CIC Prüfungsfragen mit Lösungen (Q51-Q56):

51. Frage
An infection preventionist is reviewing a wound culture result on a surgery patient. The abdominal wound culture of purulent drainage grew Staphylococcus aureus with the following sensitivity pattern: resistant to penicillin, oxacillin, cephalothin, and erythromycin; susceptible to clindamycin, and vancomycin. The patient is currently being treated with cefazolin. Which of the following is true?

A. This is a methicillin-sensitive S. aureus (MSSA) strain.
B. The current therapy is not effective.
C. The wound is not infected.
D. Droplet Precautions should be initiated.

Antwort: B

Begründung:
The scenario involves a surgical patient with a purulent abdominal wound culture growing Staphylococcus aureus, a common pathogen in surgical site infections (SSIs). The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes accurate interpretation of culture results and antibiotic therapy in the
"Identification of Infectious Disease Processes" and "Prevention and Control of Infectious Diseases" domains, aligning with the Centers for Disease Control and Prevention (CDC) guidelines for managing SSIs. The question requires assessing the sensitivity pattern and current treatment to determine the correct statement.
Option B, "The current therapy is not effective," is true. The wound culture shows Staphylococcus aureus resistant to oxacillin, indicating methicillin-resistant S. aureus (MRSA). The sensitivity pattern lists resistance to penicillin, oxacillin, cephalothin, and erythromycin, with susceptibility to clindamycin and vancomycin.
Cefazolin, a first-generation cephalosporin, is ineffective against MRSA because resistance to oxacillin (a penicillinase-resistant penicillin) implies cross-resistance to cephalosporins like cefazolin due to altered penicillin-binding proteins (PBPs). The CDC's "Guidelines for the Prevention of Surgical Site Infections" (2017) and the Clinical and Laboratory Standards Institute (CLSI) standards confirm that MRSA strains are not susceptible to cefazolin, meaning the current therapy is inappropriate and unlikely to resolve the infection, supporting Option B.
Option A, "The wound is not infected," is incorrect. The presence of purulent drainage, a clinical sign of infection, combined with a positive culture for S. aureus, confirms an active wound infection. The CBIC and CDC define purulent discharge as a key indicator of SSI, ruling out this statement. Option C, "Droplet Precautions should be initiated," is not applicable. Droplet Precautions are recommended for pathogens transmitted via respiratory droplets (e.g., influenza, pertussis), not for S. aureus, which is primarily spread by contact. The CDC's "Guideline for Isolation Precautions" (2007) specifies Contact Precautions for MRSA, not Droplet Precautions, making this false. Option D, "This is a methicillin-sensitive S. aureus (MSSA) strain," is incorrect. Methicillin sensitivity is determined by susceptibility to oxacillin, and the resistance to oxacillin in the culture result classifies this as MRSA, not MSSA. The CDC and CLSI use oxacillin resistance as the defining criterion for MRSA.
The CBIC Practice Analysis (2022) and CDC guidelines stress the importance of aligning antimicrobial therapy with sensitivity patterns to optimize treatment outcomes. The mismatch between cefazolin and the MRSA sensitivity profile confirms that Option B is the correct statement, indicating ineffective current therapy.
References:
* CBIC Practice Analysis, 2022.
* CDC Guidelines for the Prevention of Surgical Site Infections, 2017.
* CDC Guideline for Isolation Precautions, 2007.
* CLSI Performance Standards for Antimicrobial Susceptibility Testing, 2022.

52. Frage
During the past week, three out of four blood cultures from a febrile neonate in an intensive care unit grew coagulase-negative staphylococci. This MOST likely indicates:

A. Contamination.
B. Laboratory error.
C. Colonization.
D. Infection.

Antwort: A

Begründung:
The scenario involves a febrile neonate in an intensive care unit (ICU) with three out of four blood cultures growing coagulase-negative staphylococci (CoNS) over the past week. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes accurate interpretation of microbiological data in the
"Identification of Infectious Disease Processes" domain, aligning with the Centers for Disease Control and Prevention (CDC) guidelines for healthcare-associated infections. Determining whether this represents a true infection, contamination, colonization, or laboratory error requires evaluating the clinical and microbiological context.
Option B, "Contamination," is the most likely indication. Coagulase-negative staphylococci, such as Staphylococcus epidermidis, are common skin flora and frequent contaminants in blood cultures, especially in neonates where skin preparation or sampling technique may be challenging. The CDC's "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (2017) and the Clinical and Laboratory Standards Institute (CLSI) note that multiple positive cultures (e.g., two or more) are typically required to confirm true bacteremia, particularly with CoNS, unless accompanied by clear clinical signs of infection (e.g., worsening fever, hemodynamic instability) and no other explanation. The inconsistency (three out of four cultures) and the neonate's ICU setting-where contamination from skin or catheter hubs is common-suggest that the positive cultures likely result from contamination during blood draw rather than true infection. Studies, such as those in the Journal of Clinical Microbiology (e.g., Beekmann et al., 2005), indicate that CoNS in blood cultures is contaminated in 70-80% of cases when not supported by robust clinical correlation.
Option A, "Laboratory error," is possible but less likely as the primary explanation. Laboratory errors (e.g., mislabeling or processing mistakes) could occur, but the repeated growth in three of four cultures suggests a consistent finding rather than a random error, making contamination a more plausible cause. Option C,
"Colonization," refers to the presence of microorganisms on or in the body without invasion or immune response. While CoNS can colonize the skin or catheter sites, colonization does not typically result in positive blood cultures unless there is an invasive process, which is not supported by the data here. Option D,
"Infection," is the least likely without additional evidence. True CoNS bloodstream infections (e.g., catheter- related) in neonates are serious but require consistent positive cultures, clinical deterioration (e.g., persistent fever, leukocytosis), and often imaging or catheter removal confirmation. The febrile state alone, with inconsistent culture results, does not meet the CDC's criteria for diagnosing infection (e.g., at least two positive cultures from separate draws).
The CBIC Practice Analysis (2022) and CDC guidelines stress differentiating contamination from infection to avoid unnecessary treatment, which can drive antibiotic resistance. Given the high likelihood of contamination with CoNS in this context, Option B is the most accurate answer.
References:
* CBIC Practice Analysis, 2022.
* CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2017.
* Beekmann, S. E., et al. (2005). Coagulase-Negative Staphylococci in Blood Cultures. Journal of Clinical Microbiology.
* CLSI Guidelines on Blood Culture Interpretation, 2018.

53. Frage
Essential knowledge, behaviors, and skills that an individual should possess and demonstrate to practice in a specific discipline defines which of the following?

A. Training
B. Knowledge
C. Competence
D. Certification

Antwort: C

Begründung:
The correct answer is B, "Competence," as it defines the essential knowledge, behaviors, and skills that an individual should possess and demonstrate to practice in a specific discipline. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, competence encompasses the integrated application of knowledge, skills, and behaviors required to perform effectively in a professional role, such as infection prevention and control. Competence goes beyond mere knowledge or training by including the ability to apply these attributes in real-world scenarios, ensuring safe and effective practice (CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competency 4.3 - Assess competence of healthcare personnel). This holistic definition is critical in healthcare settings, where demonstrated competence-through actions like proper hand hygiene or outbreak management-directly impacts patient safety and infection prevention outcomes.
Option A (certification) refers to a formal recognition or credential (e.g., CIC certification) that validates an individual's qualifications, but it is an outcome or process rather than the definition of the underlying abilities.
Option C (knowledge) represents the theoretical understanding or factual basis of a discipline, which is a component of competence but not the full scope that includes behaviors and skills. Option D (training) involves the education or instruction provided to develop skills and knowledge, serving as a means to achieve competence rather than defining it.
The focus on competence aligns with CBIC's emphasis on ensuring that healthcare personnel are equipped to meet the demands of infection prevention through a combination of education, practice, and evaluation (CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competency 4.2 - Evaluate the effectiveness of educational programs). This definition supports the development of professionals who can adapt and perform effectively in dynamic healthcare environments.
References: CBIC Practice Analysis, 2022, Domain IV: Education and Research, Competencies 4.2 - Evaluate the effectiveness of educational programs, 4.3 - Assess competence of healthcare personnel.

54. Frage
In which of the following ways is human immunodeficiency virus similar to the Hepatitis B virus?

A. Needlestick exposure leads to a high frequency of healthcare worker infection
B. Transmission may occur from asymptomatic carriers
C. The primary mechanism of transmission for both is maternal-fetal
D. The risk of infection from mucous membrane exposure is the same

Antwort: B

Begründung:
The human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) are both bloodborne pathogens that pose significant risks in healthcare settings, and understanding their similarities is crucial for infection prevention and control. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the importance of recognizing transmission modes and implementing appropriate precautions in the
"Prevention and Control of Infectious Diseases" domain, aligning with guidelines from the Centers for Disease Control and Prevention (CDC). Comparing these viruses involves evaluating their epidemiology, transmission routes, and occupational risks.
Option C, "Transmission may occur from asymptomatic carriers," is the correct answer. Both HIV and HBV can be transmitted by individuals who are infected but show no symptoms, making asymptomatic carriage a significant similarity. For HBV, chronic carriers (estimated at 257 million globally per WHO, 2019) can transmit the virus through blood, semen, or other bodily fluids without overt signs of disease. Similarly, HIV- infected individuals can remain asymptomatic for years during the latent phase, yet still transmit the virus through sexual contact, blood exposure, or perinatal transmission. The CDC's "Guidelines for Prevention of Transmission of HIV and HBV to Healthcare Workers" (1987, updated 2011) and "Epidemiology and Prevention of Viral Hepatitis" (2018) highlight this shared characteristic, underscoring the need for universal precautions regardless of symptom status.
Option A, "The primary mechanism of transmission for both is maternal-fetal," is incorrect. While maternal- fetal transmission (perinatal transmission) is a significant route for both HIV and HBV-occurring in 5-10% of cases without intervention for HBV and 15-45% for HIV without antiretroviral therapy-it is not the primary mechanism. For HBV, the primary mode is horizontal transmission through unprotected sexual contact or percutaneous exposure (e.g., needlesticks), accounting for the majority of cases. For HIV, sexual transmission and intravenous drug use are the leading modes globally, with maternal-fetal transmission being a smaller proportion despite its importance. Option B, "Needlestick exposure leads to a high frequency of healthcare worker infection," is partially true but not a precise similarity. Needlestick exposures carry a high risk for HBV (transmission risk ~30% if the source is HBeAg-positive) and a lower risk for HIV (~0.3%), but the frequency of infection among healthcare workers is significantly higher for HBV due to its greater infectivity and stability outside the host. This makes the statement more characteristic of HBV than a shared trait. Option D, "The risk of infection from mucous membrane exposure is the same," is false. The risk of HIV transmission via mucous membrane exposure (e.g., splash to eyes or mouth) is approximately 0.09%, while for HBV it is higher (up to 1-2% depending on viral load and exposure type), reflecting HBV's greater infectivity.
The CBIC Practice Analysis (2022) and CDC guidelines emphasize the role of asymptomatic transmission in shaping infection control strategies, such as routine testing and post-exposure prophylaxis. This shared feature of HIV and HBV justifies Option C as the most accurate similarity.
References:
* CBIC Practice Analysis, 2022.
* CDC Guidelines for Prevention of Transmission of HIV and HBV to Healthcare Workers, 2011.
* CDC Epidemiology and Prevention of Viral Hepatitis, 2018.
* WHO Hepatitis B Fact Sheet, 2019.

55. Frage
In a retrospective case-control study, the initial case group is composed of persons

A. without the risk factor under investigation
B. with the disease
C. with the risk factor under investigation
D. without the disease.

Antwort: B

Begründung:
In a retrospective case-control study, cases and controls are selected based on disease status. The case group is composed of individuals who have the disease (cases), while the control group consists of individuals without the disease. This design allows researchers to look back in time to assess exposure to potential risk factors.
Step-by-Step Justification:
* Selection of Cases and Controls:
* Cases: Individuals who already have the disease.
* Controls: Individuals without the disease but similar in other aspects.
* Direction of Study:
* A retrospective study moves backward from the disease outcome to investigate potential causes or risk factors.
* Data Collection:
* Uses past medical records, interviews, and laboratory results to determine past exposures.
* Common Use:
* Useful for studying rare diseases since cases have already occurred, making it cost-effective compared to cohort studies.
Why Other Options Are Incorrect:
* B. without the disease: (Incorrect) This describes the control group, not the case group.
* C. with the risk factor under investigation: (Incorrect) Risk factors are identified after selecting cases and controls.
* D. without the risk factor under investigation: (Incorrect) The study investigates whether cases had prior exposure, not whether they lacked a risk factor.
CBIC Infection Control References:
* APIC Text, Chapter on Epidemiologic Study Design.

56. Frage
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