CIC – Certification in Infection Control

1. Question 1 · Identifying Infectious Diseases

   A 58-year-old surgical inpatient is afebrile with a normal white blood cell count. Two blood culture sets were drawn from separate venipunctures; one set grows coagulase-negative staphylococci at 38 hours and the other set shows no growth. The patient has no central line or prosthetic material. How should the infection preventionist (IP) interpret this result?
   • A.Secondary bloodstream infection attributable to the surgical site
   • B.Probable contaminant not meeting bloodstream infection criteria
   • C.Transient bacteremia requiring repeat cultures and empiric vancomycin
   • D.Laboratory-confirmed bloodstream infection requiring NHSN reporting
   Show answer and explanation

   Answer: B. Probable contaminant not meeting bloodstream infection criteria

   Coagulase-negative staphylococci are common skin commensals; growth in only one of two sets, with delayed time to positivity and no clinical signs or intravascular device, points to contamination. NHSN requires a common commensal to be identified in two or more separately collected blood specimens plus a sign or symptom. Treating it as bacteremia and starting vancomycin is the key trap, as this drives unnecessary antibiotic use and inflates bloodstream infection counts.

2. Question 2 · Surveillance & Epidemiology

   A patient meets NHSN criteria for a healthcare-associated primary BSI with a date of event on hospital day 5 (Staphylococcus aureus). On hospital day 12 a new blood culture grows Candida albicans; the patient still has a central line. How should the IP handle the day-12 result?
   • A.Disregard the result, because yeast is a common commensal contaminant
   • B.Add Candida albicans to the existing BSI event; report no new BSI
   • C.Report a second CLABSI, because a different organism was identified
   • D.Report a new BSI with a new repeat infection timeframe beginning on day 12
   Show answer and explanation

   Answer: B. Add Candida albicans to the existing BSI event; report no new BSI

   The repeat infection timeframe is 14 days, with the date of event as day 1 (hospital days 5 through 18 here), and no new event of the same type is reported during it; additional eligible organisms are added to the original event. Reporting a second CLABSI because the organism differs is the key trap. Candida is a recognized pathogen, not a common commensal, so it cannot be disregarded.

3. Question 3 · Preventing Transmission

   A 4-month-old infant with laboratory-confirmed pertussis began azithromycin 2 days ago. The parents ask when the infant's isolation will end. Which response is accurate?
   • A.Droplet precautions continue until 5 days of effective therapy are completed
   • B.Droplet precautions continue until the paroxysmal cough fully resolves
   • C.Contact precautions continue for the entire hospital stay
   • D.Airborne precautions continue until a repeat PCR test is negative
   Show answer and explanation

   Answer: A. Droplet precautions continue until 5 days of effective therapy are completed

   Pertussis requires droplet precautions until 5 days of effective therapy are completed, so this infant needs 3 more days. The paroxysmal cough can last for weeks after the patient stops being infectious, so it is not the end point. Pertussis is not airborne, and repeat PCR can stay positive after treatment.

4. Question 4 · Preventing Transmission

   The IP must request funding for an additional IP full-time equivalent (FTE) at a meeting with the chief financial officer and chief nursing officer. Which approach is MOST likely to be effective?
   • A.Present a concise business case tying HAI trends to costs, regulatory risk, and projected return
   • B.Cite published IP staffing ratios from the literature as the sole justification for the additional position
   • C.Provide a detailed review of the NHSN surveillance definitions used to identify each HAI reported last year
   • D.Share the complete line list of all HAIs from the past year to demonstrate the current surveillance workload
   Show answer and explanation

   Answer: A. Present a concise business case tying HAI trends to costs, regulatory risk, and projected return

   Executives respond to brief, outcome-focused messages that tie the request to cost, quality, regulatory exposure, and return on investment. Staffing-ratio benchmarks are useful supporting data, but presented alone they do not show leadership what the organization gains from the investment.

5. Question 5 · Identifying Infectious Diseases

   The IP places fluorescent gel marks on 10 high-touch surfaces in a patient room before discharge. After terminal cleaning, only 4 of the 10 marks have been removed. What is the MOST appropriate interpretation and action?
   • A.Microbial bioburden exceeds acceptable limits; switch the unit to a sporicidal disinfectant
   • B.The surfaces are contaminated with pathogens; culture each unremoved mark to identify them
   • C.Thoroughness was 40%; give feedback and targeted training to EVS staff, then re-audit
   • D.The disinfectant contact time was not met; change to a product with a shorter contact time
   Show answer and explanation

   Answer: C. Thoroughness was 40%; give feedback and targeted training to EVS staff, then re-audit

   Fluorescent markers measure whether a surface was physically wiped (thoroughness of cleaning), here 4 / 10 × 100 = 40%, and results are most useful when fed back to EVS staff with education and repeat monitoring. The marker does not measure microbial contamination or contact time, so conclusions about bioburden or a product change are not supported by this method.

6. Question 6 · Identifying Infectious Diseases

   A patient with an indwelling urinary catheter has a urine culture sent as part of a routine admission order set. The patient is afebrile, has no suprapubic or flank pain, and has no change in mental status. The culture grows more than 100,000 CFU/mL of Enterococcus faecalis. What should the IP recommend?
   • A.A course of amoxicillin because the colony count exceeds the reporting threshold
   • B.Catheter exchange followed by a repeat culture to confirm the organism
   • C.No antimicrobial treatment and removal of routine urine cultures from the order set
   • D.Reporting a CAUTI to NHSN because the colony count exceeds the threshold
   Show answer and explanation

   Answer: C. No antimicrobial treatment and removal of routine urine cultures from the order set

   This is asymptomatic bacteriuria; without a qualifying sign or symptom it does not meet NHSN CAUTI criteria and should not be treated in most adults. Diagnostic stewardship calls for eliminating reflexive or routine urine cultures that detect colonization. Treating based on colony count alone is the key trap, driving resistance and C. difficile risk without benefit.

7. Question 7 · Surveillance & Epidemiology

   Patient	Devices in place	Days (of 5)
   A	PICC + hemodialysis catheter	5
   B	Indwelling urinary catheter	5
   C	Non-tunneled subclavian CVC	3
   D	Peripheral IV + radial arterial line	5

   The IP reviews device use for four ICU patients over a 5-day period, as shown in the table. How many central line-days should be reported for these patients?
   • A.10
   • B.18
   • C.13
   • D.8
   Show answer and explanation

   Answer: D. 8

   Central line-days count patients with at least one central line, not the number of lines: patient A contributes 5 days (not 10) despite two lines, and patient C contributes 3 days, for 8. Urinary catheters and peripheral IVs are not central lines, and a radial arterial line is excluded from NHSN central line counts. Counting each line separately (13) is the most common error.

8. Question 8 · Preventing Transmission

   The IP reviews the SSI prevention plan for elective colorectal surgery. Which practice is recommended as an essential practice in the current SHEA Compendium?
   • A.Razor removal of hair from the operative site the evening before surgery
   • B.Mechanical bowel preparation alone without oral antimicrobial agents
   • C.Continuation of prophylactic antibiotics for 48 hours after closure
   • D.Oral antibiotics combined with mechanical bowel preparation before surgery
   Show answer and explanation

   Answer: D. Oral antibiotics combined with mechanical bowel preparation before surgery

   For elective colorectal surgery, the SHEA Compendium lists combined oral antimicrobials plus mechanical bowel preparation as an essential practice. Continuing prophylaxis after closure increases resistance and C. difficile risk without lowering SSI rates. Razor shaving raises SSI risk, and mechanical bowel preparation alone has not been shown to reduce SSI.

9. Question 9 · Preventing Transmission

   The board quality committee asks the IP to add one outcome measure to an infection prevention scorecard that currently contains only process measures. Which measure should the IP add?
   • A.Hospital-onset MRSA bacteremia standardized infection ratio
   • B.Percentage of staff completing annual infection prevention training
   • C.Hand hygiene compliance rate by direct observation on all units
   • D.Percentage of central line insertions with a completed checklist
   Show answer and explanation

   Answer: A. Hospital-onset MRSA bacteremia standardized infection ratio

   Outcome measures reflect the result for patients, such as the rate or SIR of an HAI. Hand hygiene compliance is the most tempting distractor because it is the most widely reported IP metric, but it measures whether a practice was performed, which makes it a process measure.

10. Question 10 · Identifying Infectious Diseases

    The EVS director proposes replacing all fluorescent marker audits with ATP bioluminescence testing so the hospital can report which rooms are contaminated with MRSA and VRE. Which limitation of ATP testing should the IP explain?
    • A.ATP detects organic residue from any source and cannot identify specific pathogens
    • B.ATP detects only viable bacterial cells and misses organic soil left on the surface
    • C.ATP results use standardized units, so a single pass threshold applies to all brands
    • D.ATP testing is accurate only on porous surfaces such as privacy curtains and chairs
    Show answer and explanation

    Answer: A. ATP detects organic residue from any source and cannot identify specific pathogens

    ATP bioluminescence measures adenosine triphosphate from organic material, including food, body fluids, and dead cells, so it indicates residual soil but does not identify or quantify organisms such as MRSA or VRE. Relative light units are not standardized between manufacturers, so thresholds must be set for each system rather than applied universally.

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