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CBIC CIC考試指南 - CIC參考資料
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最新的 Infection Control CIC 免費考試真題 (Q165-Q170):
問題 #165
An infection preventionist is reviewing employee health immunization policies. What is the recommendation for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) for a 55-year-old nurse who received all childhood vaccinations?
- A. Two doses of Tdap vaccine at least 28 days apart
- B. Two doses of Tdap vaccine at least 14 days apart
- C. No additional vaccination is recommended
- D. One dose of Tdap vaccine
答案:D
解題說明:
The correct answer is A, "One dose of Tdap vaccine," as this is the recommended immunization for a 55-year- old nurse who received all childhood vaccinations. 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), adults who have completed a primary series of childhood vaccinations (typically 5 doses of DTaP or DTP) should receive a single booster dose of Tdap if they have not previously received it. This is especially critical for healthcare personnel, such as a 55-year-old nurse, due to their increased risk of exposure to pertussis and the need to protect vulnerable patients (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents). The Tdap vaccine, which protects against tetanus, diphtheria, and pertussis, is recommended once between ages 11-64, with a preference for administration in early adulthood (e.g., 19-26 years) or as soon as feasible for older adults, including this 55-year-old nurse, to ensure immunity against pertussis, which wanes over time. For individuals aged 65 and older, Tdap is still recommended if not previously received, though Tdap is preferred over Td (tetanus and diphtheria only) for healthcare workers to address pertussis risk.
Option B (two doses of Tdap vaccine at least 14 days apart) and Option C (two doses of Tdap vaccine at least
28 days apart) are not standard recommendations for adults with a complete childhood vaccination history.
Multiple doses are typically reserved for individuals with incomplete primary series or specific high-risk conditions, not for this scenario. Option D (no additional vaccination is recommended) is incorrect because, even with a complete childhood series, a Tdap booster is advised for healthcare workers to maintain protection, especially given the nurse's occupational exposure risks (CDC Immunization Schedules, 2024).
After receiving the Tdap booster, a Td booster every 10 years is recommended to maintain tetanus and diphtheria immunity, but the initial Tdap dose is the priority for this nurse.
The recommendation for one Tdap dose aligns with CBIC's emphasis on evidence-based immunization policies to prevent transmission of vaccine-preventable diseases in healthcare settings (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.1 - Collaborate with organizational leaders). This ensures the nurse is protected and contributes to herd immunity, reducing the risk of pertussis outbreaks in the healthcare environment.
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 Immunization Schedules, 2024. ACIP Recommendations for Tdap, 2011 (updated 2023).
問題 #166
Which of the following is the BEST strategy for reducing bloodstream infections associated with central venous catheters?
- A. Daily blood cultures for patients with central lines.
- B. Use of povidone-iodine instead of chlorhexidine for skin antisepsis.
- C. Use of chlorhexidine-impregnated dressings.
- D. Routine replacement of central lines every 7 days.
答案:C
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 #167
Following an outbreak of Hepatitis A, the water supply is sampled. A high count of which of the following isolates would indicate that the water was a potential source?
- A. Legionella
- B. Acinetobacter
- C. Pseudomonads
- D. Coliforms
答案:D
解題說明:
Coliform bacteria are indicators of fecal contamination in water, making them a critical measure of water safety. Hepatitis A is a virus primarily transmitted via the fecal-oral route, often through contaminated food or water.
Step-by-Step Justification:
* Fecal Contamination and Hepatitis A:
* Hepatitis A virus (HAV) spreads through ingestion of water contaminated with fecal matter. High coliform counts indicate fecal contamination and increase the risk of HAV outbreaks.
* Use of Coliforms as Indicators:
* Public health agencies use total coliforms and Escherichia coli (E. coli) as primary indicators of water safety because they signal fecal pollution.
* Waterborne Transmission of Hepatitis A:
* Hepatitis A outbreaks have been traced to contaminated drinking water, ice, and improperly treated wastewater. Coliform detection signals a need for immediate action.
Why Other Options Are Incorrect:
* B. Pseudomonads:
* Pseudomonads (e.g., Pseudomonas aeruginosa) are environmental bacteria but are not indicators of fecal contamination.
* C. Legionella:
* Legionella species cause Legionnaires' disease through inhalation of contaminated aerosols, not through fecal-oral transmission.
* D. Acinetobacter:
* Acinetobacter species are opportunistic pathogens in healthcare settings but are not indicators of waterborne fecal contamination.
CBIC Infection Control References:
* APIC Text, "Water Systems and Infection Control Measures".
* APIC Text, "Hepatitis A Transmission and Waterborne Outbreaks".
問題 #168
During an outbreak of ventilator-associated pneumonia (VAP), the infection preventionist should FIRST:
- A. Perform bacterial cultures from ventilator circuits.
- B. Isolate all ventilated patients in negative pressure rooms.
- C. Review adherence to ventilator bundle elements.
- D. Implement preemptive antibiotic therapy in all ventilated patients.
答案:C
解題說明:
* Reviewing compliance with VAP prevention bundles (e.g., head-of-bed elevation, oral care, sedation breaks) is the first step in outbreak control.
* Preemptive antibiotics (B) are not recommended due to antibiotic resistance risks.
* Negative pressure rooms (C) are not required for VAP.
* Ventilator circuit cultures (D) do not guide patient management.
CBIC Infection Control References:
* APIC Text, "VAP Prevention Measures," Chapter 11.
問題 #169
The expectation to call out or speak up when an infection prevention lapse is observed is an example of
- A. honest disclosure of a safety event.
- B. implementation of human factors.
- C. a blaming and shaming safety culture.
- D. a safety culture with reciprocal accountability.
答案:D
解題說明:
A safety culture withreciprocal accountabilityemphasizes mutual responsibility for maintaining safe practices, encouraging staff at all levels to "speak up" or "stop the line" when they observe risky practices.
This concept reflects a learning organization and a just culture that supports open communication and proactive risk mitigation.
* According to theAPIC Text, a strong safety culture is described as one where:
"The leadership can expect staff members to call out or stop the line when they see risk, and staff can expect leadership to listen and act." This dynamic reflects reciprocal accountability.
* Other options are less accurate:
* A. Human factorsrefer to system design, not behavioral accountability.
* B. Honest disclosure of a safety eventis about post-event transparency, not real-time intervention.
* C. A blaming and shaming cultureis antithetical to safety culture principles.
References:
APIC Text, 4th Edition, Chapter 18 - Patient Safety
問題 #170
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