CBIC Updated CIC Exam Questions and Answers by stanislaw

Chickenpox (varicella) is primarily spread through airborne transmission, and exposure is defined by being in the same airspace with a contagious person (from 1-2 days before rash onset until lesions are crusted), even if briefly.

The APIC Text states:

“Significant exposure is defined as being in the same room or airspace during the period of infectivity, regardless of duration”.

This reflects airborne precaution definitions and CDC exposure management guidelines for varicella.

The Certification Study Guide (6th edition) identifies inadequate cleaning and reprocessing protocols as the primary factor contributing to the formation of bacteria-containing biofilms within endoscope channels. Endoscopes have long, narrow lumens and complex internal surfaces that are particularly vulnerable to biofilm formation when organic material is not thoroughly removed. Biofilms develop when microorganisms adhere to surfaces and become embedded within a protective extracellular matrix, which significantly reduces the effectiveness of disinfectants and sterilants.

The study guide emphasizes that cleaning is the most critical step in endoscope reprocessing. Failure to promptly and thoroughly clean channels—such as delayed cleaning, insufficient brushing, inadequate flushing, or improper detergent use—allows organic debris and moisture to remain, creating ideal conditions for microbial attachment and biofilm development. Once established, biofilms are difficult to eliminate and have been implicated in healthcare-associated infections linked to endoscopic procedures.

The incorrect options describe practices that do not promote biofilm formation. Enzymatic detergents, when used correctly, support removal of organic material. Chlorine-based products are not standard for endoscope channel reprocessing and are not the primary cause of biofilm development. Centralized reprocessing areas are considered best practice because they support standardized procedures, trained personnel, and quality control.

This concept is frequently tested on the CIC exam, reinforcing that breakdowns in basic cleaning and reprocessing practices pose the greatest risk for biofilm formation and patient harm.

The CBIC Certified Infection Control Exam Study Guide (6th edition) emphasizes that a critical initial step in any outbreak investigation is for the infection preventionist to develop a strong understanding of the organism involved, its epidemiology, reservoirs, modes of transmission, and previously reported outbreak sources. Conducting a literature search of similar outbreak investigations provides this foundational knowledge and helps guide a structured, evidence-based investigation.

Pseudomonas aeruginosa is an opportunistic, water-associated pathogen frequently implicated in healthcare-associated outbreaks, particularly in ICUs. Prior outbreak investigations described in the literature commonly identify sources such as sink drains, faucets, respiratory equipment, humidifiers, contaminated medications, and inadequate reprocessing of medical devices. Reviewing published investigations allows the IP to anticipate likely sources, identify high-yield environmental sampling locations, and avoid unnecessary or unfocused interventions.

Options A and D may become appropriate later, depending on outbreak magnitude and reporting requirements, but they are not the initial step. Option B can be helpful but relies on anecdotal experience rather than systematic evidence. The Study Guide stresses that outbreak investigations should begin with background research and hypothesis generation, followed by targeted data collection and analysis.

For the CIC® exam, this question reinforces that effective outbreak management starts with understanding what is already known, making a literature review the most appropriate initial action.

When an outbreak of infectious disease is suspected, the first step is to conduct an epidemiologic investigation. This begins with characterizing the outbreak by person, place, and time to establish patterns and trends. This approach, known as descriptive epidemiology, provides critical insights into potential sources and transmission patterns.

Step-by-Step Justification:

Identify Cases and Patterns:

The infection preventionist should analyze patient demographics (person), locations of cases (place), and onset of symptoms (time). This helps in defining the outbreak scope and potential exposure sources​.

Create an Epidemic Curve:

An epidemic curve helps determine whether the outbreak is a point-source or propagated event. This can indicate whether the infection is spreading person-to-person or originating from a common source​.

Compare with Baseline Data:

Reviewing historical data ensures that the observed cases exceed the expected norm, confirming an outbreak​.

Guide Further Investigation:

Establishing basic epidemiologic patterns guides subsequent actions, such as laboratory testing, environmental sampling, and surveillance​.

Why Other Options Are Incorrect:

B. Increase surveillance facility-wide for additional cases:

While enhanced surveillance is important, it should follow the initial characterization of the outbreak. Surveillance without a defined case profile may lead to misclassification and misinterpretation​.

C. Contact the laboratory to confirm stool identification results:

Confirming lab results is essential but comes after defining the outbreak's characteristics. Without an epidemiologic link, testing may yield results that are difficult to interpret​.

D. Form a tentative hypothesis about the potential reservoir for this outbreak:

Hypothesis generation occurs after sufficient epidemiologic data have been collected. Jumping to conclusions without characterization may result in incorrect assumptions and ineffective control measures​.

CBIC Infection Control References:

APIC Text, "Outbreak Investigations," Epidemiology, Surveillance, Performance, and Patient Safety Measures​.

APIC/JCR Infection Prevention and Control Workbook, Chapter 4, Surveillance Program​.

APIC Text, "Investigating Infectious Disease Outbreaks," Guidelines for Epidemic Curve Analysis​.