Free CBIC CIC Practice Exam with Questions & Answers | Set: 4

The safe transport of biohazardous samples, such as infectious agents, clinical specimens, or diagnostic materials, is a critical aspect of infection prevention and control to prevent exposure and environmental contamination. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes adherence to regulatory and safety standards in the "Prevention and Control of Infectious Diseases" domain, which includes proper handling and shipping of biohazardous materials. The primary guideline governing this practice is the U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR) and the International Air Transport Association (IATA) Dangerous Goods Regulations, which align with global biosafety standards.

Option A, "Ship using triple-containment packaging," is the essential element of practice. Triple-containment packaging involves three layers: a primary watertight container holding the sample, a secondary leak-proof container with absorbent material, and an outer rigid packaging (e.g., a box) that meets shipping regulations. This system ensures that biohazardous materials remain secure during transport, preventing leaks or breaches that could expose handlers or the public. The CDC and WHO endorse this method as a fundamental requirement for shipping Category A (high-risk) and Category B (moderate-risk) infectious substances, making it the cornerstone of safe transport practice.

Option B, "Electronically log and send via overnight delivery," is a useful administrative and logistical step to track shipments and ensure timely delivery, but it is not the essential element. While documentation and rapid delivery are important for maintaining chain of custody and sample integrity, they are secondary to the physical containment provided by triple packaging. Option C, "Transport by an authorized biohazard transporter," is a necessary step to comply with regulations, as only trained and certified transporters can handle biohazardous materials. However, this is contingent on proper packaging; without triple containment, transport authorization alone is insufficient. Option D, "Store in a cooler that is labeled as a health hazard," may be part of preparation (e.g., maintaining sample temperature), but labeling alone does not address the containment or transport safety required during shipment. Coolers are often used, but the focus on labeling as a health hazard is incomplete without the triple-containment structure.

The CBIC Practice Analysis (2022) supports compliance with federal and international shipping regulations, which prioritize triple-containment packaging as the foundational practice to mitigate risks. The CDC’s Biosafety in Microbiological and Biomedical Laboratories (BMBL, 6th Edition, 2020) and IATA guidelines further specify that triple packaging is mandatory for all biohazardous shipments, reinforcing Option A as the correct answer.

An Ishikawa diagram (fishbone diagram) is used to visually represent cause-and-effect relationships in problem analysis. It is best for summarizing and categorizing issues found in a gap analysis related to infection prevention.

The APIC Text confirms:

“A fishbone diagram (also called a tree diagram or Ishikawa) allows a team to identify, explore, and graphically display all of the possible causes related to a problem to discover the root cause”.

It’s particularly useful in quality improvement and infection prevention project analysis.

10% lipid emulsions are the most likely to promote microbial growth because they provide an ideal environment for bacterial and fungal proliferation, especially Staphylococcus aureus, Pseudomonas aeruginosa, and Candida species. Lipids support rapid bacterial multiplication due to their high nutrient content.

Why the Other Options Are Incorrect?

A. 50% hypertonic glucose – High glucose concentrations inhibit bacterial growth due to osmotic pressure effects.

B. 5% dextrose – While it can support some bacterial growth, it is less favorable than lipid emulsions.

C. Synthetic amino acids – These solutions do not support microbial growth as well as lipid emulsions.

CBIC Infection Control Reference

APIC guidelines confirm that lipid-based solutions support rapid microbial growth and should be handled with strict aseptic technique​.

The best strategy to reduce the risk of infection in hemodialysis patients is to use an arteriovenous (AV) fistula as the preferred vascular access method. AV fistulas have the lowest infection rates compared to catheters and grafts because they do not involve foreign material and are less prone to biofilm formation and bloodstream infections.

Why the Other Options Are Incorrect?

B. Use of a non-cuffed percutaneous catheter – Non-cuffed catheters have a higher risk of bloodstream infections and should be used only for short-term access.

C. Placement of a femoral catheter – Femoral catheters have higher infection risks and should only be used for bed-bound patients and for the shortest duration possible.

D. Replacement of dialysis catheters monthly – Routine catheter replacement does not reduce infection risk and should be done only when medically necessary.

CBIC Infection Control Reference

According to APIC guidelines, AV fistulas are the preferred vascular access due to their lower infection rates and improved long-term outcomes​.

Among the listed pathogens, Hepatitis C has the highest risk of seroconversion following a percutaneous exposure, though it's important to note that Hepatitis B actually has the highest overall risk. However, since Hepatitis B is not listed among the options, the correct choice from the available ones is Hepatitis C.

The APIC Text confirms:

“The average risk of seroconversion after a percutaneous injury involving blood infected with hepatitis C virus is approximately 1.8 percent”.

The other options are not bloodborne pathogens typically associated with high seroconversion risks after needlestick or percutaneous exposure:

A. Shigella – transmitted fecal-orally, not percutaneously.

B. Syphilis – transmitted sexually or via mucous membranes.

C. Hepatitis A – primarily fecal-oral transmission, low occupational seroconversion risk.

Documentation of each steam sterilization cycle is a regulatory and quality requirement. It must include load contents, the sterilizer ID, date, cycle number, and the person who assembled the load. These details support traceability and quality assurance.

The APIC Text states:

“Each item or package should be labeled with a lot-control identifier that includes the sterilizer identification number or code, a detailed list of the contents, an identifier for the person who assembled the package, the date of sterilization, the cycle number...”

Other options like the machine model number or date sterilizer was cleaned are not routine documentation elements for every cycle.

The scenario describes a cluster of five out of 35 residents in a long-term care facility developing high fever, nasal discharge, and a dry cough, suggesting a potential respiratory infection outbreak. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the "Identification of Infectious Disease Processes" and "Surveillance and Epidemiologic Investigation" domains, which require selecting the most appropriate diagnostic tool to identify the causative agent promptly. The Centers for Disease Control and Prevention (CDC) provides guidance on diagnostic approaches for respiratory infections, particularly in congregate settings like long-term care facilities.

Option C, "Nasopharyngeal swab," is the best diagnostic tool in this context. The symptoms—high fever, nasal discharge, and a dry cough—are characteristic of upper respiratory infections, such as influenza, respiratory syncytial virus (RSV), or other viral pathogens common in congregate settings. A nasopharyngeal swab is the gold standard for detecting these agents, as it collects samples from the nasopharynx, where many respiratory viruses replicate. The CDC recommends nasopharyngeal swabs for molecular testing (e.g., PCR) to identify viruses like influenza, RSV, or SARS-CoV-2, especially during outbreak investigations in healthcare facilities. The dry cough and nasal discharge align with upper respiratory involvement, making this sample type more targeted than alternatives. Given the potential for rapid spread among vulnerable residents, early identification via nasopharyngeal swab is critical to guide infection control measures.

Option A, "Blood culture," is less appropriate as the best initial tool. Blood cultures are used to detect systemic bacterial infections (e.g., bacteremia or sepsis), but the symptoms described are more suggestive of a primary respiratory infection rather than a bloodstream infection. While secondary bacteremia could occur, blood cultures are not the first-line diagnostic for this presentation and are more relevant if systemic signs (e.g., hypotension) worsen. Option B, "Sputum culture," is useful for lower respiratory infections, such as pneumonia, where productive cough and sputum production are prominent. However, the dry cough and nasal discharge indicate an upper respiratory focus, and sputum may be difficult to obtain from elderly residents, reducing its utility here. Option D, "Legionella serology," is specific for diagnosing Legionella pneumophila, which causes Legionnaires’ disease, typically presenting with fever, cough, and sometimes gastrointestinal symptoms, often in association with water sources. While possible, the lack of mention of pneumonia or water exposure, combined with the upper respiratory symptoms, makes Legionella serology less likely as the best initial test. Serology also requires time for antibody development, delaying diagnosis compared to direct sampling.

The CBIC Practice Analysis (2022) and CDC guidelines for outbreak management in long-term care facilities (e.g., "Prevention Strategies for Seasonal Influenza in Healthcare Settings," 2018) prioritize rapid respiratory pathogen identification, with nasopharyngeal swabs being the preferred method for viral detection. Given the symptom profile and outbreak context, Option C is the most effective and immediate diagnostic tool to determine the causative agent.

The Certification Study Guide (6th edition) emphasizes that thorough cleaning is the most critical step in the reprocessing of all reusable medical devices, including semi-critical devices (those that contact mucous membranes or nonintact skin). A foundational requirement is that initial cleaning begins as soon as possible after use. Prompt cleaning prevents organic material—such as blood, secretions, and tissue—from drying on device surfaces and within lumens, which can shield microorganisms and significantly reduce the effectiveness of subsequent disinfection.

The study guide explains that delayed cleaning increases the risk of biofilm formation and makes removal of soil more difficult, potentially compromising patient safety. For this reason, point-of-use pre-cleaning and rapid transport to reprocessing are considered minimum expectations. Cleaning must occur before any high-level disinfection or sterilization; without effective cleaning, even correctly selected disinfectants may fail.

The other options are incorrect or misleading. There is no universal requirement for detergents with pH lower than 7; detergent selection should follow manufacturer instructions. Waiting 24 hours before cleaning is contrary to best practice and increases risk. Soaking devices in liquid chemical sterilants for extended periods does not address the prerequisite of cleaning and may not be appropriate for semi-critical devices unless specified by the manufacturer.

This question reflects a key CIC exam principle: timely cleaning is non-negotiable and is the cornerstone of safe device reprocessing.

The Certification Study Guide (6th edition) stresses that valid comparison of infection rates requires consistent surveillance definitions and methodologies. When comparing a facility’s central line–associated bloodstream infection (CLABSI) rates to those reported in a national database, the single most important consideration is the use of the same case definition for central line infection. Without standardized definitions, rate comparisons are unreliable and may lead to incorrect conclusions about performance.

National databases rely on precise, standardized criteria for what constitutes a CLABSI, including timing, clinical signs, laboratory confirmation, and attribution to a central line. If a facility applies different criteria—such as alternative timing windows, inclusion/exclusion rules, or diagnostic thresholds—the resulting rates may be artificially higher or lower than benchmark data. The study guide emphasizes that comparability hinges on alignment of numerators (cases) and denominators (central line days) using identical definitions.

The other options, while relevant to prevention practices or contextual understanding, are not primary requirements for valid comparison. Skin preparation methods and types of lines influence risk but do not ensure comparability of reported rates. Facility size can affect risk profiles, but standardized definitions allow for risk adjustment within databases.

This question reflects a core CIC exam principle: benchmarking is meaningful only when surveillance definitions are consistent. Ensuring alignment with national definitions is foundational to accurate performance evaluation and quality improvement.

The CBIC Certified Infection Control Exam Study Guide (6th edition) identifies direct touch contamination by personnel as the most common cause of contamination of compounded pharmaceutical products. Human contact—particularly hands, gloves, sleeves, or improper manipulation of sterile components—is the greatest source of microbial contamination during compounding activities.

Even when engineering controls such as laminar airflow workbenches and cleanrooms are functioning correctly, contamination can occur if aseptic technique is not strictly followed. Touching sterile vial stoppers, syringe tips, needle hubs, or critical sites with nonsterile hands or gloves introduces microorganisms directly into the product. The Study Guide emphasizes that aseptic technique, hand hygiene, glove use, and competency validation are essential to preventing contamination.

Option B, inadequate laminar airflow, can contribute to contamination but is less common than direct touch errors and is usually detected through certification and monitoring. Option C, infrequent environmental sampling, does not cause contamination but may delay detection of problems. Option D, inappropriate storage, can affect product stability but is not the primary cause of contamination during compounding.

For CIC® exam preparation, it is critical to recognize that human factors are the leading source of contamination in sterile compounding. Infection prevention strategies therefore focus heavily on staff training, competency assessment, observation, and adherence to aseptic technique standards to reduce contamination risk.