New Document Mcqs Epidemiology
New Document Mcqs Epidemiology
New Document Mcqs Epidemiology
Answers:
1. D
2. E
3. F
4. A
5. B
6. C
Page 1 of 51
Pre-Quiz Questions (slide 34)
Q. What precautions do we use with every patient?
Q. What precautions do we use with a patient that may have whooping cough?
Answer:
• Pull the staff aside individually and use this “teachable moment” to discuss
proper PPE use and why this is so important
• Identify personnel on the unit who can assist in improving practices
(administrator, physical or other champion, direct care personnel, others…); form
a team
• Send the CDC and other related guidelines for preventing transmission of
infections to these personnel
• Collaborate with unit personnel to identify barriers to proper PPE use; how PPE
use can be improved; availability of PPE, etc.
• Reeducate the staff
• Observe and/or audit on rounds at later time for improvement
Page 2 of 51
Infection Preventionist as an Educator Answer Key
Answers:
• Assess Needs – Identify what topics need to be taught
• Lesson Plan - Create a step by step plan
• Determine teaching method – Formal lecture or 1:1
• Preparation – Objectives, materials, location and timing is establish at this step
• Evaluation – Determine success of the education
Page 3 of 51
Life as a Detective and NHSN Basics Answer Key
Pre-Quiz Question (slide 2)
Q. The most essential component of an effective Infection Prevention surveillance
program is:
A. The capability to monitor everything
B. Collection of meaningful data
C. Outbreak detection
D. Complying with accreditation agencies
Scenario 1 (slide 4)
Q. Which of the following you would include in your presentation:
Page 4 of 51
Pre-Quiz Definitions (slide 15)
Match the term on the right with a definition on the left.
Answers:
• Indicators – D
• Process – A
• Outcome – F
• Risk adjusted – E
• Infection rate – B
• Case – D
• Cluster – G
Answers:
1. Outcome
2. Process
3. Process
4. Outcome
Page 5 of 51
Quick Quiz (slide 35)
Q. Label Each As Either Passive Or Active Surveillance
1. MRSA screening
2. Reportable disease reports
3. Laboratory reports
4. Hand hygiene compliance
5. Prevention standards observations
6. Blood-borne pathogen reports
Answers:
1. Active
2. Passive
3. Passive
4. Active
5. Active
6. Passive
In addition to all of the facility types listed on this slide, Long Term Acute Care (LTAC)
and Long Term Care (LTC) facilities can also report to NHSN.
Page 6 of 51
Pre-Quiz Question #2 (slide 63)
Q. The NHSN Infection Window Period is defined as the 5-days during which all site-
specific infection criteria must be met. It includes the day the first positive diagnostic test
that is used as an element of the site-specific infection criterion was obtained, the two
calendar days before and the two calendar days after.
A. True
B. False
Answer: B. False
The NHSN Infection Window Period is defined as the 7-days during which all site-
specific infection criteria must be met. It includes the day the first positive diagnostic test
that is used as an element of the site-specific infection criterion was obtained, the 3
calendar days before and the 3 calendar days after.
• IWP – Is the Infection Window Period. It’s the 7-days during which all site-specific
infection criteria must be met.
• DOE – is the Date of Event…It’s date the first element used to meet a site-
specific infection criterion occurs for the first time within the IWP
• HAI – is a Healthcare-Associated Infection of course: DOE occurs on or after the
3rd calendar day of admission to an inpatient location
• SBAP – You just learned about that one…That’s the Secondary Bloodstream
Attribution Period…The period in which a blood specimen must be collected for a
secondary bloodstream infection to be attributed to a primary site infection.
• POA – POA is present on admission…DOE occurs the day of admission, 2 days
prior to admission, or the day after admission to an inpatient location
• RIT – is the Repeat Infection Timeframe…the 14-day timeframe during which no
new infections of the same type are reported.
Page 7 of 51
Recap Quiz! Question 1 (slide 118)
Q, It’s ok to allow my Infectious Disease physician to overrule my NHSN HAI
determinations as long as he has clinical documentation to support his decision.
A. True
B. False
Answer: B. False
It is NEVER ok to allow anyone, no matter their role in your organization, to change your
HAI determination unless they are better able to apply NHSN definitions to your case.
Answer: B. RIT
Answer: A. True
Answer: B. False
The patient must report their actual temperature, such as 100.6, and it be documented
in the medical record. It is not sufficient for the patient to only say they had a fever.
Page 8 of 51
Recap Quiz! Question 5 (slide 122)
Q. Which of the following is/are considered a diagnostic test and can be used to set an
infection window period?
A. Laboratory specimen collection
B. Imaging Test
C. Procedure or Exam
D. All of the above
Page 9 of 51
CAUTI Answer Key
Pre-Quiz Questions (slide 3)
Q. For NHSN CAUTI surveillance, the collection date of the positive urine culture always
sets the Infection Window Period.
A. True
B. False
Answer: A. True
The collection date of a positive urine culture always sets the Infection Window Period,
provided it meets the NHSN criteria of having no more than 2 species of organisms, one
of which is a bacteria >105 CFU/ml. Pay close attention to the dates on the lab reports
and don’t confuse the report date with the collection date.
Page 10 of 51
Case Scenario 1 – Question 1 (slide 28)
Q. Does this patient have an HAI?
A. Yes
B. No
Answer: A. Yes
This patient has an HAI because the Date of Event occurred on the 4th calendar day of
admission to an inpatient location.
Page 11 of 51
Case Scenario 2 (slide 31)
The patient has a foley >2 calendar days, no s/s of UTI during the IWP and a positive
blood culture that matches an organism in the urine that is growing >100,000 cfu/ml.
Page 12 of 51
Case Scenario 2 – Question 2 (slide 33)
Q. What is the Date of Event?
A. 6/2
B. 5/31
C. 6/3
D. 6/6
Answer: C, 6/3
The date the first element used to meet an NHSN site-specific infection criterion (in this
case the positive blood culture) occurs for the first time within the seven-day infection
window period. Remember, if you have a positive blood culture, you should continue to
monitor for additional positive cultures throughout the Infection Window Period and
secondary attribution period. Do not assume that the patient has a primary BSI because
the first positive culture is a positive blood.
Case Scenario 3 (slide 35)
• 4/10 - 75 year old female admitted to ICU with possible sepsis; urine culture on
admission is positive for >100,000 cfu/ml E. coli, blood cultures x2 are negative;
patient has no signs or symptoms of a UTI.
• 4/11 - Patient has temp of 100.8; no dysuria, frequency, urgency, CVA pain, or
suprapubic tenderness
• 4/12 – Temp of 100.2; foley placed
• 4/15 – Urine culture positive for >100,000 cfu/ml E. coli
• 4/17 – Temp of 101.0
Answer: B, No.
Although the patient has a fever and positive urine culture during the first 2 days of
admission (in the POA period), this patient does not have a NHSN UTI because fever
cannot be used as a UTI criterion in a patient >65 years of age when a foley is not in
place.
Page 13 of 51
Case Scenario 3 – Question 2 (slide 37)
Q. Since this patient did not have a UTI Present on Admission, do they have a CAUTI
resulting from the second positive urine culture? If so, what is the Date of Event?
A. Yes, they have a SUTI 1a with DOE of 4/15
B. No, they do not have a CAUTI since the urine culture on 4/15 grew the same
organism as the urine culture Present on Admission
C. Yes, they have a SUTI 1a with a DOE of 4/17
D. Yes, they have a SUTI 1b with a DOE of 4/15
Page 14 of 51
Case Scenario 4 – Question 1 (slide 40)
Q. Does the patient have a UTI on 9/22?
A. Yes, SUTI 1a
B. No
C. Yes, ABUTI
D. Yes, SUTI 1b
The patient has a temp >38C and a positive urine growing >100,000 cfu/ml of a
bacteria, but does not have a foley for >2 calendar days, so it’s a SUTI 1b.
Answer: B, No
This patient has a second SUTI on 9/30, in the Repeat Infection Timeframe of the 9/22
SUTI. You do not change the device association during a Repeat Infection Timeframe.
Even though the patient had a foley >2 calendar days at the time of the 9/30 SUTI, you
would not change the 9/22 non-catheter associated SUTI to a catheter-associated.
If the non-catheter associated UTI on 9/22 were reported to NHSN, the Klebsiella
pneumoniae from the 9/30 SUTI would be reported along with the E. coli from the 9/22
SUTI since the 9/30 SUTI fell into the 14-day Repeat Infection Timeframe of the 9/22
SUTI.
If you only report CAUTI to NHSN, this case would not be reported.
Page 15 of 51
Case Scenario 5 (slide 44)
The positive urine culture on 7/15 sets an Infection Window Period of 7/12-7/18. The
dysuria occurs on 7/12 and that is the first symptom of the UTI within the Infection
Window Period.
Did you notice the positive urine culture occurred 4 days after the foley was removed?
When reviewing positive urine cultures, don’t assume you don’t have a CAUTI because
there was no foley in place the day before the urine culture was collected. You need to
look back 4 days from the date of the urine culture to ensure you have no symptoms of
a UTI or foley in place.
Page 16 of 51
Case Scenario 5 – Question 2 (slide 46)
Q. What organism(s) is/are reported for the CAUTI?
A. Pseudomonas aeruginosa
B. Candida albicans
C. Pseudomonas aeruginosa and Candida albicans
Answer: A. ICU
Per the Transfer Rule: If the date of the event is the day of transfer/discharge or the day
after, the infection is attributed to the transferring location. In this case, the DOE is 7/12
and the patient was transferred from ICU to med/surg unit on the day before. Since the
ICU was the transferring unit on 7/11, that is the Location of Attribution.
Page 17 of 51
CLABSI Case Scenarios Answer Key
Applying BSI Definitions
Case Scenario 5 (slide 42)
Answer: A. Yes
This is a CLABSI. Patient has a CL in place >2 calendar days and a recognized
pathogen identified from 1 or more blood cultures and the organism is not related to an
infection at another site.
Page 18 of 51
Case Scenario 2 (slide 46)
Patient has a CL >2 calendar days, a fever and a common commensal is identified from
two blood specimens drawn on separate occasions and consecutive calendar days and
organisms are not related to an infection at another site.
Staph epidermidis and Coagulase negative Staph are considered matching organisms
because Staph epidermidis is a Coagulase negative Staph.
Page 19 of 51
Case Scenario 2 – Question 2 (slide 48)
Q. What is the date of first diagnostic test?
A. 1/16
B. 1/14
C. 1/17
Answer: A. 1/16
The matching common commensals represent a single criteria, therefore the date of the
FIRST common commensal is the date of the first diagnostic test
Answer: B. No, patient has a BSI Present on Admission with a DOE of 7/14
The patient does have a BSI and it is present on admission with a DOE of 7/14; the first
sign of infection is bradycardia occurring on the day after admission to an inpatient
location. This is within the POA period, therefore the patient does not have HAI.
Page 20 of 51
Case Scenario 3 – Question 2 (slide 52)
Q. What type of BSI does this patient have?
A. LCBI 2
B. LCBI 1
C. LCBI 3
Answer: C. LCBI 3
Patient has a LCBI 3, they have apnea, bradycardia, the same common commensal is
identified from two or more blood specimens drawn on separate occasions, and
organism identified is not related to an infection at another site
Page 21 of 51
Case Scenario 4 – Question 1 (slide 55)
Q. Does this patient have a CLABSI?
A. Yes, one LCBI 1 with DOE of 8/25
B. No
C. Yes, LCBI 1 with DOE of 8/18 and a second LCBI 1 on 8/25 in the RIT
D. Yes, one LCBI with a DOE of 8/18
Answer: C. Yes, LCBI 1 with DOE of 8/18 and a second LCBI 1 on 8/25 in the RIT
Patient has a CL >2 calendar days, positive blood cultures on 8/18 with a recognized
pathogen and no other source of infection is identified. On 8/25 the patient again has a
recognized pathogen with no other source identified. The LCBI on 8/25 falls into the 14-
day RIT of the 8/18 LCBI.
The pathogen from the 8/18 CLABSI is reported and the pathogen from the 8/25 BSI is
also reported on the 8/18 CLABSI since it falls within the 14-day RIT of that HAI.
Answer: A. Med/Surg.
Per the Transfer Rule: If the date of the event is the day of transfer/discharge or the day
after, the infection is attributed to the transferring location. In this case, the DOE is 8/18
and the patient was transferred from Med/Surg to Telemetry on the day before.
Since the med/surg unit was the transferring unit on 8/17, that is the Location of
Attribution.
Page 22 of 51
Case Scenario 5 (slide 59)
Answer: C. 5/14
The device day count begins on 5/12 for the purpose of denominator CL day count, but
it begins on 5/14 for the purpose of determining device attribution since that is the first
day the line is accessed on an inpatient unit. This line will continue to be counted until it
is discontinued or the day after patient discharge.
Answer: B. MBI-LCBI-1
Patient has a CL>2 calendar days, at least on blood specimen with an intestinal
organism from the MBI organism list and 2 separate days of ANC or total WBC <500
cells/mm3 within a 7 day period [date of positive blood culture, 3 calendar days before,
and 3 calendar days after])
Page 23 of 51
Case Scenario 5 – Question 3 (slide 62)
Q. What is the Date of Event?
A. 5/19
B. 5/17
C. 5/20
D. 5/18
Answer: A. 5/19
For MBI-LCBIs, ANC/WBC levels should not be used to set the IWP or to identify the
date of event. MBI-LCBIs are subsets of LCBIs and therefore the date of the LCBI
would be the date of the MBI-LCBI event.
Page 24 of 51
CLABSI Case Scenarios Answer Key
Secondary Bloodstream Infection Determination
Case Scenario 1 (slide 65)
Page 25 of 51
Case Scenario 1 – Question 2 (slide 67)
Q. What organism(s) is/are reported to NHSN?
A. E. coli
B. Staph aureus
C. E. coli and Staph aureus
Page 26 of 51
Case Scenario 2 – Question 1 (slide 70)
Q. What HAI does this patient have?
A. CLABSI
B. BSI secondary to VAE
C. Pneumonia (PNU2) only
D. BSI secondary to PNU2
The patient has a PNU2 with 2 serial CXR showing new and persistent infiltrates, a
temp >100.4, tachypnea, and organisms identified from the blood in the IWP. Because
the organism in the blood specimen is an element used to meet the NHSN PNU2
infection and is collected within the PNU2 IWP, the BSI is secondary to the PNU2.
The first imaging test (or chest x-ray) is the first diagnostic test setting the IWP for the
PNU2.
Answer: B. No.
Page 27 of 51
Case Scenario 3 (slide 74)
The IAB 3b site-specific criteria is met with nausea and vomiting with no other
recognized cause, fever, positive blood culture with a MBI organism and imaging
evidence of an infection. The secondary BSI criteria is met because an organism
identified in the blood specimen is an element that is used to meet the NHSN site-
specific infection criterion, and is collected during the site-specific infection window
period.
Page 28 of 51
Case Scenario 3 – Question 2 (slide 77)
Q. Could this abdominal abscess be an organ space surgical site infection attributed to
the patient’s gallbladder surgery on 11/5?
A. Yes
B. No
Answer: B. No
This cannot be a SSI because the surveillance period for cholecystectomy (CHOL) is 30
days and the signs and symptoms of the IAB began after the surveillance period.
Page 29 of 51
Risk Assessment Answer Key
Pre-Quiz Question (slide 3)
Q. The purpose of the risk assessment is to act as a guide and focus for your annual
infection control plan.
A. True
B. False
Answer: A. True
Answer: A. True
Scenario 1 (slide 6)
Q. Once you’ve identified the risk, what are the three main components that need to be
evaluated to conduct the risk assessment?
A. The probability of the event occurring
B. The names of the individuals responsible for the breach
C. The Impact or severity if the event occurs
D. Your current systems or level of preparedness for the event
E. Hand hygiene compliance rates in the procedural area where the risk was
identified
Answer: A, C, D
Page 30 of 51
Scenario 2: CLABSI (slide 7)
Q. You have completed a risk assessment for your organization and identified central
line-associated bloodstream infections (CLABSI) as the top priority for your infection
prevention program. The risk assessment team develops a CLABSI rate goal for the
organization. The team then has to develop measurable objectives and strategies to
meet those objectives.
You do not need to develop an evaluation method for your objectives at this time?
A. True
B. False
Answer: B. False
Answers: A, B, C
Page 31 of 51
Pre-Quiz Question: Risk Assessment Team (slide 12)
Q. Which of the following services should be part of the risk assessment team?
A. Infection Prevention staff
B. Environmental Services
C. Pharmacy
D. Laboratory
E. Nursing
F. Central Processing
G. Other
H. All of the above
Answer: A. True
Answers: C, D, F
Page 32 of 51
Pre-Quiz (slide 40)
Q. What are the benefits of using a group to complete the risk assessment?
A. Creates a group that is knowledgeable about infection prevention
B. Getting buy-in from key stakeholders
C. No single individual will be blamed for priorities
D. All of the above
E. None of the above
Page 33 of 51
MDROs and Other Infectious Diseases of Interest for the
Infection Preventionist Answer Key
Quick Quiz Match (slide 34)
1. Normally lives in the intestinal tract MRSA
but is resistant to Vancomycin
Answers:
1. Enterococcus
2. MRSA
3. Carbapenem resistant Enterobacteriaceae
4. Antibiotic Stewardship
Answers:
1. Infected with TB, but it’s not active
2. Negative pressure room
3. Used to prevent inhalation of airborne diseases
4. Tuberculin skin test
Page 34 of 51
Quick Quiz Match (slide 93)
1. Call the local PHD First
Answers:
1. Second
2. Third
3. First
4. Fourth
Answers:
1. Very low, 0.4 cases per 100,000 population in non-outbreak areas
2. Finger foods are famous for transmitting bacteria
3. Fecal-oral route
4. As long as 50 days
Page 35 of 51
Activity: What do you think the IP should do? (slide 96)
True or False
Answers:
1. True
2. False
3. True
4. True
Answers:
1. 90%
2. Standard and Droplet
3. One day
4. Cover your cough
Page 36 of 51
Quick Quiz Match (slide 146)
Answers:
1. Airborne
2. From reactivation of herpes zoster
3. Airborne and contact
4. Standard
Page 37 of 51
Surveillance: VAE and LabID Answer Key
Answer: E. B, C, and D are all appropriate scenarios for using pneumonia/VAP criteria.
What Are the Daily Minimum PEEP and FiO2? (slide 30)
A. 5 and 0.40
B. 8 and 0.60
C. 10 and 1.0
D. 5 and 0.60
Time 6 pm 7 pm 8 pm 9 pm 10 pm 11 pm
Peep (cmH2O) 10 8 5 5 8 8
FiO2 1.0 0.60 0.40 0.50 0.60 0.60
Page 38 of 51
Outbreak Investigation Exercise
Answer Key
Formula is:
# new cases in population in given period x 10n*
# in same population during given period
2 x 100 = 1.7
120
How we state our findings is important: This result is stated as “the incidence rate of
MRSA in the ICU in June is 1.7 cases per 100 patients”
What is attack rate for MRSA in June? We use 100 as the constant, so it’s the same as
we calculated above—1.7 cases per 100 patients or 1.7%. Note that attack rate is most
commonly used for foodborne outbreaks.
Attack rate is really a proportion of persons at risk who become infected over an entire
period of exposure. There is no specification of time. Always a percent.
Page 39 of 51
Prevalence Rate (slides 41-43)
Answers:
• # new patients in ICU with MRSA in June = 2
• # patients with MRSA in May still in ICU in June = 3
• # patients in ICU in June = 120
Formula is:
# new and existing cases of MRSA x 100
# ICU pts in June
Besides being able to use the formula, you must be able to explain the result you
obtain. This is stated as a “the prevalence rate of MRSA in the ICU in June is 4.2 cases
per 100 patients”
Notice the difference between the MRSA prevalence and incidence rates in June:
Prevalence rate is 4.2 cases per 100 patients – this rate includes both new and existing
cases
Incidence rate is 1.7 cases per 100 patients and includes only newly diagnosed patients
Page 40 of 51
Incidence-Density Rate (slides 44-45)
Answer:
Formula is:
# Infections X 1000 = rate
# Patient (or resident) - days in total population
Stated as: There were 5.9 UTIs per 1,000 resident-days in May. Remember that we
cannot express an incidence density rate as a percentage.
State rate as: there were 1.6 CLABSIs per 1,000 catheter-days in the MICU in April
Page 41 of 51
Cleaning, Disinfection and Sterilization Answer Key
How would you classify these? (slide 21)
Item Classification
1. Endoscopes A. Non-critical
2. Endoscopy biopsy forceps B. Semi-critical
3. Blood pressure cuff C. Critical
4. Scalpel
5. PACU recovery chair
Answers:
1. B
2. C
3. A
4. C
5. A
Page 42 of 51
Quick Quiz (slide 61)
True or False: Immediate use sterilization can be used in lieu of purchasing additional
instrument sets.
Answer: False
Page 43 of 51
Surgical Site Infection (SSI) Answer Key
Case 1: Is this procedure primarily closed? (slide 14)
• A patient is admitted with a ruptured diverticulum and a COLO procedure is
performed in the inpatient OR.
• Surgeon staples closed the skin at 4 locations with packing placed between the
staples
Answer: Yes, this procedure is primarily closed because the surgeon stapled closed the
skin at 4 locations.
Answer: YES
The PATOS field would be selected as YES since there was evidence of infection (an
abscess was documented) at the time of surgery and the subsequent SSI developed at
the same level. Infections that meet SSI criteria and have the PATOS field as a YES are
still reported to NHSN.
Answer: No
The PATOS field would be selected as NO since the level of infection at the time of the
procedure was organ space and the level of the SSI 3 weeks later was superficial.
Page 44 of 51
Case 4: Does this meet the PATOS criteria? (slide 20)
• During an unplanned cesarean section (CSEC) the surgeon nicks the bowel and
there is contamination of the intraabdominal cavity.
• One week later the patient returns and meets criteria for an organ space OREP
(other reproductive) SSI.
Answer: No
The PATOS field would be selected as NO since there was no documentation of
evidence of infection or abscess at the time of the CSEC. The colon nick was a
complication but there was no infection present at the time of surgery. Contamination
does not equal infection.
Page 45 of 51
Case Scenario 2 (slide 37)
Answer: B. Nothing
Page 46 of 51
Case Scenario 3 (slide 40)
The fact that the patient was colonized with MRSA preoperatively does not mean that
there is not a SSI. The patient had no evidence of infection at the incision site at the
time of surgery, so it won’t be classified as PATOS. It’s a fact that patients who are
colonized with MRSA will have an increased risk of developing an MRSA SSI.
Page 47 of 51
Case Scenario 4 (slide 43)
Page 48 of 51
Case Scenario 4 (cont.) (slide 48)
Answer: No
Although an anastomotic leak can be a complication of surgery, the fact remains that
this patient meets the criterion for an SSI. If the surgery had not been performed there
would not have been an anastomotic leak.
Page 49 of 51
Case Scenario 5 (slide 49)
Why isn’t this an IAB? Remember the site specific locations for an IAB that we
discussed in Case #4? IAB doesn’t include the pelvic area.
Page 50 of 51
Using and Reporting Data Answer Key
Pre-Quiz Questions (slide 3)
Q. Bright colors and 3-D effects produce the most easy-to-understand graphs and
charts.
A. True
B. False
Answer: False
Use the fewest number of visual effects necessary to communicate data to your
audience. The most important rule in presenting your data is to make it easily
understandable to the intended audience. Remember, pretty charts can’t make up for
bad data.
The advantage to using a SIR is the ability to compare performance to all others that
use the same data collection methodology.
Page 51 of 51