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最新的 Infection Control CIC 免費考試真題 (Q91-Q96):
問題 #91
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. Droplet Precautions should be initiated.
- C. The current therapy is not effective.
- D. The wound is not infected.
答案:C
解題說明:
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.
問題 #92
Which of the following is the BEST strategy for reducing bloodstream infections associated with central venous catheters?
- A. Use of povidone-iodine instead of chlorhexidine for skin antisepsis.
- B. Use of chlorhexidine-impregnated dressings.
- C. Routine replacement of central lines every 7 days.
- D. Daily blood cultures for patients with central lines.
答案:B
解題說明:
* Chlorhexidine-impregnated dressings reduce central line-associated bloodstream infections (CLABSI) by preventing bacterial colonization.
* Routine catheter replacement (A) increases insertion risks without reducing infections.
* Daily blood cultures (C) are unnecessary and lead to false positives.
* Povidone-iodine (D) is less effective than chlorhexidine for skin antisepsis.
CBIC Infection Control References:
* APIC Text, "CLABSI Prevention Measures," Chapter 10.
問題 #93
Which of the following options describes a correct use of personal protective equipment?
- A. Eye protection should be worn when providing patient care it at risk of spreading respiratory disease after unprotected exposure.
- B. Gloves should be worn when handling or touching a cardiac monitor that has been disinfected.
- C. Personal eyeglasses should be worn during suctioning.
- D. Surgical masks should be worn during lumbar puncture procedures.
答案:D
解題說明:
According toCDC and APIC guidelines, asurgical mask is requiredwhen performinglumbar puncturesto prevent bacterial contamination (e.g., meningitis caused by droplet transmission of oral flora).
Why the Other Options Are Incorrect?
* A. Personal eyeglasses should be worn during suctioning-Incorrectbecauseeyeglasses do not provide adequate eye protection. Goggles or face shields should be used.
* C. Gloves should be worn when handling or touching a cardiac monitor that has been disinfected- Not necessaryunless recontamination is suspected.
* D. Eye protection should be worn when providing patient care after unprotected exposure- Eye protection should be usedbefore exposure, not just after.
CBIC Infection Control Reference
APIC states that surgical masks must be worn for procedures such as lumbar puncture to reduce infection risk.
問題 #94
An HBsAb-negative employee has a percutaneous exposure to blood from a Hepatitis B surface antigen (HBsAg) positive patient. Which of the following regimens is recommended for this employee?
- A. Hepatitis B vaccine alone
- B. Hepatitis B immune globulin (HBIG) alone
- C. Hepatitis B immune globulin (HBIG) and hepatitis B vaccine
- D. Immune serum globulin and hepatitis B vaccine
答案:C
解題說明:
The correct answer is D, "Hepatitis B immune globulin (HBIG) and hepatitis B vaccine," as this is the recommended regimen for an HBsAb-negative employee with a percutaneous exposure to blood from an HBsAg-positive patient. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, which align with recommendations from the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), post-exposure prophylaxis (PEP) for hepatitis B virus (HBV) exposure depends on the employee's vaccination status and the source's HBsAg status. For an unvaccinated or known HBsAb-negative individual (indicating no immunity) exposed to HBsAg-positive blood, the standard PEP includes both HBIG and the hepatitis B vaccine. HBIG provides immediate passive immunity by delivering pre-formed antibodies, while the vaccine initiates active immunity to prevent future infections (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents). The HBIG should be administered within 24 hours of exposure (preferably within 7 days), and the first dose of the vaccine should be given concurrently, followed by the complete vaccine series.
Option A (immune serum globulin and hepatitis B vaccine) is incorrect because immune serum globulin (ISG) is a general immunoglobulin preparation and not specific for HBV; HBIG, which contains high titers of anti-HBs, is the appropriate specific immunoglobulin for HBV exposure. Option B (hepatitis B immune globulin [HBIG] alone) is insufficient, as it provides only temporary passive immunity without initiating long- term active immunity through vaccination, which is critical for an unvaccinated individual. Option C (hepatitis B vaccine alone) is inadequate for immediate post-exposure protection, as it takes weeks to develop immunity, leaving the employee vulnerable in the interim.
The recommendation for HBIG and hepatitis B vaccine aligns with CBIC's emphasis on evidence-based post- exposure management to prevent HBV transmission in healthcare settings (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.1 - Collaborate with organizational leaders).
This dual approach is supported by CDC guidelines, which prioritize rapid intervention to reduce the risk of seroconversion following percutaneous exposure (CDC Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV, 2013).
References: CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competencies 3.1 - Collaborate with organizational leaders, 3.2 - Implement measures to prevent transmission of infectious agents. CDC Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV, 2013.
問題 #95
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.
答案:B
解題說明:
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.
問題 #96
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