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CBIC Certified Infection Control Exam 認定 CIC 試験問題 (Q17-Q22):
質問 # 17
The infection preventionist understands that the heating, ventilation and air conditioning (HVAC) systems in the facility can be a risk factor for healthcare-acquired infections. What is the MOST likely risk from the HVAC system for patients in a Pediatric Oncology unit?
- A. Clostridioides difficile
- B. Aspergillus spp.
- C. Norovirus
- D. Methicillin-resistant Staphylococcus aureus (MRSA)
正解:B
解説:
Patients in pediatric oncology units are highly immunocompromised, making them particularly susceptible to opportunistic fungal infections such asAspergillusspp. HVAC systems, especially if improperly maintained or contaminated, can disseminate fungal spores into patient care areas.
* According to theAPIC Text (Chapter 116 - HVAC Systems), fungal spores such asAspergilluscan be transmitted via HVAC systems. These infections have been linked to contaminated air ducts, faulty air filters, and construction-related air disturbances. Outbreaks of aspergillosis are frequently associated with construction near patient care areas and are particularly dangerous for immunocompromised patients, including pediatric oncology patients.
* Additional data fromAPIC Text (Chapter 45 - Infection Prevention in Oncology Patients)reinforces thatAspergillusspp. infections in oncology and immunocompromised patients are primarily airborne and are most often disseminated via HVAC systems.
* Incorrect answer rationale:
* A. MRSA- Typically spread via direct contact, not HVAC.
* B. Norovirus- Spread via fecal-oral route and contaminated surfaces, not airborne HVAC.
* D.Clostridioides difficile- Spread via contact with spores on surfaces, not through the air.
References:
APIC Text, 4th Edition, Chapter 116 - Heating, Ventilation, and Air Conditioning APIC Text, 4th Edition, Chapter 45 - Infection Prevention in Oncology and Immunocompromised Patients
質問 # 18
Assume the mean age of onset for patients with tuberculosis (TB) is 62 years, with one standard deviation of
5 years, and the age of onset follows a normal distribution. What is the percentage of patients expected to have the age of onset ranging from 57 to 67 years?
- A. 34%
- B. 99%
- C. 68%
- D. 95%
正解:C
解説:
To determine the percentage of patients with an age of onset ranging from 57 to 67 years, we need to apply the properties of a normal distribution. In a normal distribution, the mean represents the central point, and the standard deviation defines the spread of the data. Here, the mean age of onset is 62 years, and the standard deviation is 5 years. The range of 57 to 67 years corresponds to one standard deviation below the mean (62 - 5
= 57) to one standard deviation above the mean (62 + 5 = 67).
In a normal distribution, approximately 68% of the data falls within one standard deviation of the mean (i.e., between # - # and # + #, where # is the mean and # is the standard deviation). This is a well-established statistical principle, often referred to as the 68-95-99.7 rule (or empirical rule) in statistics. Specifically, 34% of the data lies between the mean and one standard deviation above the mean, and another 34% lies between the mean and one standard deviation below the mean, totaling 68% for the range spanning one standard deviation on both sides of the mean.
Let's verify this:
* The lower bound (57 years) is exactly one standard deviation below the mean (62 - 5 = 57).
* The upper bound (67 years) is exactly one standard deviation above the mean (62 + 5 = 67).
* Thus, the range from 57 to 67 years encompasses the middle 68% of the distribution.
Option A (34%) represents the percentage of patients within one standard deviation on only one side of the mean (e.g., 62 to 67 or 57 to 62), not the full range. Option C (95%) corresponds to approximately two standard deviations from the mean (62 ± 10 years, or 52 to 72 years), which is wider than the given range.
Option D (99%) aligns with approximately three standard deviations (62 ± 15 years, or 47 to 77 years), which is even broader. Since the question specifies a range of one standard deviation on either side of the mean, the correct answer is 68%, corresponding to Option B.
In infection control, understanding the distribution of disease onset ages can help infection preventionists identify at-risk populations and allocate resources effectively, aligning with the CBIC's focus on surveillance and data analysis (CBIC Practice Analysis, 2022). While the CBIC does not directly address statistical calculations in its core documents, the application of normal distribution principles is a standard epidemiological tool endorsed in public health guidelines, which inform CBIC practices.
References:
* CBIC Practice Analysis, 2022.
* Public Health Epidemiology Guidelines, Normal Distribution and Empirical Rule (commonly accepted statistical standards).
質問 # 19
Working with public health agencies to collect and analyze indicators that might signal an increase in community illness is an example of which type of surveillance?
- A. Targeted
- B. Passive
- C. Syndromic
- D. Active
正解:C
解説:
Surveillance is a critical tool in infection prevention and control, used to monitor disease trends and guide public health responses. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the "Surveillance and Epidemiologic Investigation" domain, which aligns with the Centers for Disease Control and Prevention (CDC) "Principles of Epidemiology in Public Health Practice" (3rd Edition, 2012).
The question describes a process of collecting and analyzing indicators to signal an increase in community illness, requiring identification of the appropriate surveillance type among the options provided.
Option C, "Syndromic," is the correct answer. Syndromic surveillance involves monitoring non-specific health indicators or symptoms (e.g., fever, respiratory complaints, or gastrointestinal issues) that may precede a formal diagnosis, aiming to detect potential outbreaks or increases in community illness early. The CDC defines syndromic surveillance as the real-time or near-real-time collection, analysis, and interpretation of health-related data to provide actionable information, often in collaboration with public health agencies. This approach uses data from sources like emergency department visits, over-the-counter medication sales, or absenteeism reports to identify trends before laboratory confirmation, making it well-suited to the described scenario of signaling community illness increases.
Option A, "Passive," involves healthcare providers or laboratories reporting cases to public health authorities on a voluntary or mandatory basis without active prompting (e.g., routine notifiable disease reporting). While passive surveillance contributes to baseline data, it is less proactive and not specifically designed to signal early increases in illness, making it less fitting. Option B, "Active," entails public health officials actively seeking data from healthcare facilities or providers (e.g., calling to confirm cases during an outbreak). This is more resource-intensive and typically used for specific investigations rather than ongoing community trend monitoring, which aligns better with syndromic methods. Option D, "Targeted," refers to surveillance focused on a specific population, disease, or event (e.g., monitoring TB in a high-risk group). The scenario's broad focus on community illness indicators does not suggest a targeted approach.
The CBIC Practice Analysis (2022) and CDC guidelines highlight syndromic surveillance as a key strategy for early detection of community-wide health threats, often involving collaboration with public health agencies. Option C best matches the described activity of analyzing indicators to signal illness increases, making it the correct choice.
References:
* CBIC Practice Analysis, 2022.
* CDC Principles of Epidemiology in Public Health Practice, 3rd Edition, 2012.
* CDC Syndromic Surveillance Systems, 2020.
質問 # 20
A patient with suspected active tuberculosis is being transferred from a mental health facility to a medical center by emergency medical services. Which of the following should an infection preventionist recommend to the emergency medical technician (EMT)?
- A. Place an N95 respirator on both the patient and the EMT.
- B. Place a surgical mask on the patient and an N95 respirator on the EMT.
- C. Place a surgical mask on both the patient and the EMT.
- D. Place an N95 respirator on the patient and a surgical mask on the EMT.
正解:D
解説:
Active tuberculosis (TB) is an airborne disease transmitted through the inhalation of droplet nuclei containing Mycobacterium tuberculosis. Effective infection control measures are critical during patient transport to protect healthcare workers, such as emergency medical technicians (EMTs), and to prevent community spread. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the use of appropriate personal protective equipment (PPE) and source control as key strategies in the "Prevention and Control of Infectious Diseases" domain, aligning with guidelines from the Centers for Disease Control and Prevention (CDC).
For a patient with suspected active TB, the primary goal is to contain the infectious particles at the source (the patient) while ensuring the EMT is protected from inhalation exposure. Option C, placing an N95 respirator on the patient and a surgical mask on the EMT, is the most appropriate recommendation. The N95 respirator on the patient serves as source control by filtering the exhaled air, reducing the dispersion of infectious droplets. However, fitting an N95 respirator on the patient may be challenging, especially in an emergency setting or if the patient is uncooperative, so a surgical mask is often used as an alternative source control measure. For the EMT, a surgical mask provides a basic barrier but does not offer the same level of respiratory protection as an N95 respirator. The CDC recommends that healthcare workers, including EMTs, use an N95 respirator (or higher-level respiratory protection) when in close contact with a patient with suspected or confirmed active TB, unless an airborne infection isolation room is available, which is not feasible during transport.
Option A is incorrect because placing a surgical mask on both the patient and the EMT does not provide adequate respiratory protection for the EMT. Surgical masks are not designed to filter small airborne particles like those containing TB bacilli and do not meet the N95 standard required for airborne precautions. Option B is impractical and unnecessary, as placing an N95 respirator on both the patient and the EMT is overly restrictive and logistically challenging, especially for the patient during transport. Option D reverses the PPE roles, placing the surgical mask on the patient (insufficient for source control) and the N95 respirator on the EMT (appropriate for protection but misaligned with the need to control the patient's exhalation). The CBIC and CDC guidelines prioritize source control on the patient and respiratory protection for the healthcare worker, making Option C the best fit.
This recommendation is consistent with the CBIC's emphasis on implementing transmission-based precautions (CDC, 2005, Guideline for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Settings) and the use of PPE tailored to the mode of transmission, as outlined in the CBIC Practice Analysis (2022).
References:
* CBIC Practice Analysis, 2022.
* CDC Guideline for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Settings,
2005.
質問 # 21
The infection preventionist (IP) is assisting pharmacists in investigating medication contamination at the hospital's compounding pharmacy. As part of the medication recall process, the IP should:
- A. Inspect for safe injection practices.
- B. Identify the potential source of contamination.
- C. Have laboratory culture all medication.
- D. Inform all discharged patients of potential medication contamination.
正解:B
解説:
The scenario involves an infection preventionist (IP) assisting pharmacists in addressing medication contamination at the hospital's compounding pharmacy, with a focus on the medication recall process. The IP' s role is to apply infection control expertise to mitigate risks, guided by the Certification Board of Infection Control and Epidemiology (CBIC) principles and best practices. The recall process requires a systematic approach to identify, contain, and resolve the issue, and the "first" or most critical step must be determined.
Let's evaluate each option:
* A. Have laboratory culture all medication: Culturing all medication to confirm contamination is a valuable step to identify affected batches and guide the recall. However, this is a resource-intensive process that depends on first understanding the scope and source of the problem. Without identifying the potential source of contamination, culturing all medication could be inefficient and delay the recall.
This step is important but secondary to initial investigation.
* B. Inspect for safe injection practices: Inspecting for safe injection practices (e.g., single-use vials, proper hand hygiene, sterile technique) is a critical infection control measure, especially in compounding pharmacies where contamination often arises from procedural errors (e.g., reuse of syringes, improper cleaning). While this is a proactive step to prevent future contamination, it addresses ongoing practices rather than the immediate recall process for the current contamination event. It is a complementary action but not the first priority.
* C. Identify the potential source of contamination: Identifying the potential source of contamination is the foundational step in the recall process. This involves investigating the compounding environment (e.
g., water quality, equipment, personnel practices), raw materials, and production processes to pinpoint where the contamination occurred (e.g., bacterial ingress, cross-contamination). The CBIC emphasizes root cause analysis as a key infection prevention strategy, enabling targeted recalls, corrective actions, and prevention of recurrence. This step is essential before culturing, inspecting, or notifying patients, making it the IP's primary responsibility in this context.
* D. Inform all discharged patients of potential medication contamination: Notifying patients is a critical step to ensure public safety and allow for medical follow-up if they received contaminated medication.
However, this action requires prior identification of the contaminated batches and their distribution, which depends on determining the source and confirming the extent of the issue. Premature notification without evidence could cause unnecessary alarm and is not the first step in the recall process.
The best answer is C, as identifying the potential source of contamination is the initial and most critical step in the medication recall process. This allows the IP to collaborate with pharmacists to trace the contamination, define the affected products, and guide subsequent actions (e.g., culturing, inspections, notifications). This aligns with CBIC's focus on systematic investigation and risk mitigation in healthcare-associated infection events.
References:
* CBIC Infection Prevention and Control (IPC) Core Competency Model (updated 2023), Domain III:
Prevention and Control of Infectious Diseases, which includes identifying sources of contamination in healthcare settings.
* CBIC Examination Content Outline, Domain V: Management and Communication, which emphasizes root cause analysis during outbreak investigations.
* CDC Guidelines for Safe Medication Compounding (2022), which recommend identifying contamination sources as the first step in a recall process.
質問 # 22
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