CBIC Updated CIC Exam Questions and Answers by faye

An epidemic curve, commonly used in infection prevention and control to visualize the progression of an outbreak, is a graphical representation of the number of cases over time. According to the principles outlined by the Certification Board of Infection Control and Epidemiology (CBIC), an epidemic curve is most effectively displayed using a bar graph or histogram that tracks the number of new cases by date or time interval (e.g., daily, weekly) without revealing patient identifiers, ensuring compliance with privacy regulations such as HIPAA. Option C aligns with this standard practice, as it specifies preparing a bar graph with no patient identifiers, focusing solely on the number of cases over a specific period. This allows infection preventionists to identify patterns, such as the peak of the outbreak or potential sources of transmission, while maintaining confidentiality.

Option A is incorrect because listing case names and room numbers with a logarithmic scale violates patient privacy and is not a standard method for constructing an epidemic curve. Logarithmic scales are typically used for data with a wide range of values, but they are not the preferred format for epidemic curves, which prioritize clarity over time. Option B is also incorrect, as using medical record numbers and scatter plots to show days in the facility to onset does not align with the definition of an epidemic curve, which focuses on case counts over time rather than individual patient timelines or scatter plot formats. Option D is inappropriate because a scatter plot by patient location emphasizes spatial distribution rather than the temporal progression central to an epidemic curve. While location data can be useful in outbreak investigations, it is typically analyzed separately from the epidemic curve.

The CBIC emphasizes the importance of epidemic curves in the "Identification of Infectious Disease Processes" domain, where infection preventionists use such tools to monitor and control outbreaks (CBIC Practice Analysis, 2022). Specifically, the use of anonymized data in graphical formats is a best practice to protect patient information while providing actionable insights, as detailed in the CBIC Infection Prevention and Control (IPC) guidelines.

The CBIC Certified Infection Control Exam Study Guide (6th edition) aligns with CDC guidance regarding interpretation of the tuberculin skin test (TST) in healthcare personnel. For a healthy individual with no known risk factors for tuberculosis, a TST is considered positive only when induration is ≥10 mm. In this scenario, the employee’s TST result of 7 mm induration is negative and does not meet the threshold for latent TB infection.

A prior history of BCG vaccination does not change interpretation criteria in adults. The CDC explicitly recommends that TST results be interpreted regardless of BCG history, as vaccine-related reactivity typically wanes over time and induration should not be attributed to BCG alone. Therefore, a 7 mm reaction in a low-risk, asymptomatic healthcare worker does not require further diagnostic evaluation.

Option A (chest x-ray) is reserved for individuals with a positive TB test or symptoms suggestive of active TB. Option C (repeat testing) is not indicated unless this was part of a two-step baseline test and the first result was negative in a newly hired employee, which is not the case here. Option D is inappropriate because treatment is only considered after confirmed latent TB infection.

For the CIC® exam, it is essential to recognize that no further action is required when TST induration is below the positive threshold for the individual’s risk category, even in those with prior BCG vaccination.

The Certification Study Guide (6th edition) emphasizes that an outbreak should be suspected when there is an unexpected clustering of infections by time, place, and person, particularly when cases share a common exposure or procedure. Option D meets all key criteria for outbreak suspicion: the same organism (methicillin-resistant Staphylococcus aureus), the same location (cardiac ICU), a common procedure (cardiac surgery), and a tight time frame (same week). This constellation strongly suggests possible transmission related to surgical practices, postoperative care, or shared equipment.

The other scenarios reflect situations that do not necessarily indicate an outbreak. Routine environmental cultures are not recommended for outbreak detection and often do not correlate with patient infection risk. An apparent increase in ventilator-associated pneumonia following implementation of a new case definition is likely due to surveillance artifact, not true transmission. Similarly, increases in carbapenemase-producing Klebsiella pneumoniae after adoption of new laboratory breakpoints reflect diagnostic changes, not an epidemiologic event.

The study guide stresses the importance of distinguishing true outbreaks from pseudo-outbreaks caused by changes in definitions, testing methods, or surveillance intensity. CIC exam questions frequently test this concept. Recognizing a true outbreak requires linking cases through epidemiologic characteristics—not simply increases in numbers.

Prompt recognition of true outbreaks enables timely investigation, implementation of control measures, and prevention of further transmission.

The selection of an appropriate antiseptic for the insertion of an intravascular device (e.g., peripheral or central venous catheters) is a critical infection prevention measure to reduce the risk of catheter-related bloodstream infections (CRBSIs). The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes evidence-based practices in the "Prevention and Control of Infectious Diseases" domain, which includes adhering to guidelines for aseptic technique during invasive procedures. The Centers for Disease Control and Prevention (CDC) provides specific recommendations for skin antisepsis, as outlined in the "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (2017).

Option A, chlorhexidine, is the preferred antiseptic for skin preparation prior to intravascular device insertion in adults with no contraindications. Chlorhexidine, particularly in a 2% chlorhexidine gluconate (CHG) with 70% isopropyl alcohol solution, is recommended by the CDC due to its broad-spectrum antimicrobial activity, residual effect (which continues to kill bacteria after application), and superior efficacy compared to other agents in reducing CRBSI rates. Studies cited in the CDC guidelines demonstrate that chlorhexidine-based preparations significantly lower infection rates compared to povidone-iodine or alcohol alone, making it the gold standard for this procedure when tolerated by the patient.

Option B, povidone-iodine, is an alternative antiseptic that can be used for skin preparation. It is effective against a wide range of microorganisms and is often used when chlorhexidine is contraindicated (e.g., in patients with chlorhexidine allergy). However, its efficacy is less persistent than chlorhexidine, and it requires longer drying time, which can be a limitation in busy clinical settings. The CDC considers povidone-iodine a second-line option unless chlorhexidine is unavailable or unsuitable. Option C, alcohol (e.g., 70% isopropyl or ethyl alcohol), has rapid bactericidal activity but lacks a residual effect, making it less effective for prolonged protection during catheter dwell time. It is often used as a component of chlorhexidine-alcohol combinations but is not recommended as a standalone antiseptic for intravascular device insertion. Option D, antibiotic ointment, is not appropriate for skin preparation during insertion. Antibiotic ointments (e.g., bacitracin or mupirocin) are sometimes applied to catheter sites post-insertion to prevent infection, but their use is discouraged by the CDC due to the risk of promoting antibiotic resistance and fungal infections, and they are not classified as antiseptics for initial skin antisepsis.

The CBIC Practice Analysis (2022) supports the adoption of CDC-recommended practices, and the 2017 CDC guidelines explicitly state that chlorhexidine-based preparations with alcohol should be used for skin antisepsis unless contraindicated. For a patient with no contraindications, the infection preventionist should suggest chlorhexidine to optimize patient safety and align with best practices.