Free CBIC CIC Practice Exam with Questions & Answers | Set: 8

The correct answer is A, "Pregnant persons," as they should be excluded from receiving the live attenuated influenza virus (LAIV) vaccine. 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), the LAIV, commonly known as the nasal spray flu vaccine, contains a live attenuated form of the influenza virus. This vaccine is contraindicated in pregnant individuals due to the theoretical risk of the attenuated virus replicating and potentially harming the fetus, despite limited evidence of adverse outcomes (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents). Pregnant persons are instead recommended to receive the inactivated influenza vaccine (IIV), which is considered safe during pregnancy.

Option B (healthy persons aged 2 to 49) is incorrect because this group is generally eligible to receive LAIV, provided they have no other contraindications, as the vaccine is approved for healthy, non-pregnant individuals in this age range (CDC Immunization Schedules, 2024). Option C (persons with allergies to chicken feathers) is not a contraindication for LAIV; the vaccine is produced in eggs, and while egg allergy was historically a concern, current guidelines indicate that LAIV can be administered to persons with egg allergies if they can tolerate egg in their diet, with precautions managed by healthcare providers. Option D (persons simultaneously receiving an inactivated vaccine) is also incorrect, as LAIV can be co-administered with inactivated vaccines without issue, according to ACIP recommendations, as there is no significant interference between the two vaccine types.

The exclusion of pregnant persons reflects CBIC’s emphasis on tailoring infection prevention strategies, including vaccination programs, to protect vulnerable populations while minimizing risks (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.1 - Collaborate with organizational leaders). This decision is based on precautionary principles outlined in CDC and ACIP guidelines to ensure maternal and fetal safety (CDC Prevention and Control of Seasonal Influenza with Vaccines, 2023).

A safety culture with reciprocal accountability emphasizes 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 the APIC 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 factors refer to system design, not behavioral accountability.

B. Honest disclosure of a safety event is about post-event transparency, not real-time intervention.

C. A blaming and shaming culture is antithetical to safety culture principles.

The CBIC Certified Infection Control Exam Study Guide (6th edition) identifies nontuberculous mycobacteria (NTM), including Mycobacterium fortuitum, as organisms commonly associated with water sources, particularly potable water systems. An unusual increase in M. fortuitum–positive bronchoscopy cultures is most often linked to waterborne contamination during endoscope reprocessing, making rinsing with tap water the most likely cause.

Tap water is not sterile and may harbor NTM, which are resistant to standard municipal water treatment and capable of forming biofilms within plumbing systems. If bronchoscopes are rinsed with tap water after high-level disinfection and not followed by appropriate sterile or filtered water rinses and thorough drying, organisms such as M. fortuitum may contaminate internal channels. This can lead to pseudo-outbreaks, where cultures are positive due to contamination rather than true patient infection.

Option B, inadequate cleaning prior to disinfection, can contribute to overall reprocessing failure but is less specifically associated with NTM contamination patterns. Option A is unlikely, as sporicidal solutions are effective disinfectants. Option D, drying with air or alcohol, is a recommended step to reduce microbial growth and would not cause contamination.

For CIC® exam preparation, recognizing that tap water exposure during endoscope reprocessing is a classic source of nontuberculous mycobacteria contamination is a key concept in outbreak investigation and device reprocessing surveillance.

Ventilator-associated events (VAEs) are complications that occur in patients receiving mechanical ventilation and include conditions such as ventilator-associated pneumonia (VAP), pulmonary edema, and atelectasis. The CBIC Certified Infection Control Exam Study Guide (6th edition) emphasizes that patient positioning plays a critical role in preventing aspiration and subsequent respiratory complications in mechanically ventilated patients.

Maintaining patients in a supine position, particularly during transport, increases the risk of aspiration of gastric contents and oropharyngeal secretions. Aspiration is a well-recognized contributing factor to the development of VAEs because it can lead to infection, inflammation, and worsening oxygenation. The Study Guide recommends maintaining the head of the bed elevated (generally 30–45 degrees) whenever feasible, including during care activities and transport, to reduce aspiration risk.

The other options listed—daily sedation vacation, daily weaning assessment, and daily oral care with chlorhexidine—are evidence-based prevention strategies that are part of ventilator care bundles. These interventions are designed to reduce the duration of mechanical ventilation, improve pulmonary function, and decrease microbial colonization, all of which lower the risk of VAEs rather than contribute to them.

Therefore, supine positioning during transport is the most likely factor contributing to an increase in ventilator-associated events and represents a deviation from recommended infection prevention practices.

The attack rate, a key epidemiological measure in outbreak investigations, is defined as the proportion of individuals who become ill after exposure to a suspected source, calculated as the number of cases divided by the population at risk. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes accurate outbreak analysis in the "Surveillance and Epidemiologic Investigation" domain, aligning with the Centers for Disease Control and Prevention (CDC) "Principles of Epidemiology in Public Health Practice" (3rd Edition, 2012). The question involves a foodborne illness outbreak linked to a church festival, requiring the selection of the most appropriate denominator to reflect the population at risk.

Option D, "Residents in the county who attended the festival," is the most appropriate denominator. The attack rate should be based on the total number of people exposed to the potential source of the outbreak (i.e., the festival), as this represents the population at risk for developing the foodborne illness. The CDC guidelines for foodborne outbreak investigations recommend using the number of attendees or participants as the denominator when the exposure is tied to a specific event, such as a festival. This approach accounts for all individuals who had the opportunity to consume the implicated food, providing a comprehensive measure of risk. Obtaining an accurate count of attendees may involve festival records, surveys, or estimates, but it directly reflects the exposed population.

Option A, "People admitted to hospitals with gastrointestinal symptoms," is incorrect as a denominator. This represents the number of cases (the numerator), not the total population at risk. Using cases as the denominator would invalidate the attack rate calculation, which requires a distinct population base. Option B, "Admission tickets sold to the festival," could serve as a proxy for attendees if all ticket holders attended, but it may overestimate the at-risk population if some ticket holders did not participate or underestimate it if additional guests attended without tickets. The CDC advises using actual attendance data when available, making this less precise than Option D. Option C, "Dinners served at the festival," is a potential exposure-specific denominator if the illness is linked to a particular meal. However, without confirmation that all cases are tied to a single dinner event (e.g., a specific food item), this is too narrow and may exclude attendees who ate other foods or did not eat but were exposed (e.g., via cross-contamination), making it less appropriate than the broader attendee count.

The CBIC Practice Analysis (2022) and CDC guidelines stress the importance of defining the exposed population accurately for attack rate calculations in foodborne outbreaks. Option D best captures the population at risk associated with festival attendance, making it the most appropriate denominator.

The CDC recommends exclusion of healthcare workers with pertussis until completing at least five days of antibiotic therapy​.

CBIC Infection Control References:

APIC-JCR Workbook, "Occupational Health Considerations," Chapter 10​

The incidence rate measures new cases of infection in a population over a defined time period using the formula:

Why the Other Options Are Incorrect?

B. Disease specific – Refers to infections caused by a particular pathogen, not the general rate of new infections.

C. Point prevalence – Measures existing cases at a specific point in time, not new cases.

D. Period prevalence – Includes both old and new cases over a set period, unlike incidence, which only considers new cases.

CBIC Infection Control Reference

APIC defines incidence rate as the number of new infections in a population over a given period​.

When an infection preventionist (IP) identifies an increase in primary bloodstream infections (BSIs) associated with peripheral intravenous (IV) catheter insertion, the initial step in outbreak investigation and process improvement is to stratify the data to identify potential sources or patterns of infection. According to the Certification Board of Infection Control and Epidemiology (CBIC), the "Surveillance and Epidemiologic Investigation" domain emphasizes the importance of systematically analyzing data to pinpoint contributing factors, such as location, technique, or equipment use, in healthcare-associated infections (HAIs). The question specifies poor technique as a suspected cause, and the first step should focus on contextual factors that could influence technique variability.

Option A, stratifying infections by the location of IV insertion (pre-hospital, Emergency Department, or in-patient unit), is the most logical first step. Different settings may involve varying levels of training, staffing, time pressure, or adherence to aseptic technique, all of which can impact infection rates. For example, pre-hospital settings (e.g., ambulance services) may have less controlled environments or less experienced personnel compared to in-patient units, potentially leading to technique inconsistencies. The CDC’s Guidelines for the Prevention of Intravascular Catheter-Related Infections (2017) recommend evaluating the context of catheter insertion as a critical initial step in investigating BSIs, making this a priority for the IP to identify where the issue is most prevalent.

Option B, stratifying by the type of dressing used (gauze, CHG impregnated sponge, or transparent), is important but should follow initial location-based analysis. Dressings play a role in maintaining catheter site integrity and preventing infection, but their impact is secondary to the insertion technique itself. Option C, stratifying by the site of insertion (hand, forearm, or antecubital fossa), is also relevant, as anatomical sites differ in infection risk (e.g., the hand may be more prone to contamination), but this is a more specific factor to explore after broader contextual data is assessed. Option D, stratifying by the type of skin preparation used (alcohol, CHG/alcohol, or iodophor), addresses antiseptic efficacy, which is a key component of technique. However, without first understanding where the insertions occur, it’s premature to focus on skin preparation alone, as technique issues may stem from systemic factors across locations.

The CBIC Practice Analysis (2022) supports a stepwise approach to HAI investigation, starting with broad stratification (e.g., by location) to guide subsequent detailed analysis (e.g., technique-specific factors). This aligns with the CDC’s hierarchical approach to infection prevention, where contextual data collection precedes granular process evaluation. Therefore, the IP should first stratify by location to establish a baseline for further investigation.

Epidemiologic Investigation:

The first step in an outbreak response is to characterize cases by person, place, and time​.

Identifying common exposures (e.g., ventilators, catheters, or contaminated surfaces) helps determine the source​.

Why Other Options Are Incorrect:

A. Universal contact precautions: Premature; precautions should be tailored based on transmission patterns.

C. Environmental sampling: Should be done after identifying epidemiologic links.

D. Decolonization protocols: Not routinely recommended for Acinetobacter outbreaks.

CBIC Infection Control References:

CIC Study Guide, "Epidemiologic Investigations in Outbreaks," Chapter 4​.

Active tuberculosis (TB) is an airborne disease transmitted through the inhalation of droplet nuclei containing Mycobacterium tuberculosis. Effective infection control measures are critical during patient transport to protect healthcare workers, such as emergency medical technicians (EMTs), and to prevent community spread. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the use of appropriate personal protective equipment (PPE) and source control as key strategies in the "Prevention and Control of Infectious Diseases" domain, aligning with guidelines from the Centers for Disease Control and Prevention (CDC).

For a patient with suspected active TB, the primary goal is to contain the infectious particles at the source (the patient) while ensuring the EMT is protected from inhalation exposure. Option C, placing an N95 respirator on the patient and a surgical mask on the EMT, is the most appropriate recommendation. The N95 respirator on the patient serves as source control by filtering the exhaled air, reducing the dispersion of infectious droplets. However, fitting an N95 respirator on the patient may be challenging, especially in an emergency setting or if the patient is uncooperative, so a surgical mask is often used as an alternative source control measure. For the EMT, a surgical mask provides a basic barrier but does not offer the same level of respiratory protection as an N95 respirator. The CDC recommends that healthcare workers, including EMTs, use an N95 respirator (or higher-level respiratory protection) when in close contact with a patient with suspected or confirmed active TB, unless an airborne infection isolation room is available, which is not feasible during transport.

Option A is incorrect because placing a surgical mask on both the patient and the EMT does not provide adequate respiratory protection for the EMT. Surgical masks are not designed to filter small airborne particles like those containing TB bacilli and do not meet the N95 standard required for airborne precautions. Option B is impractical and unnecessary, as placing an N95 respirator on both the patient and the EMT is overly restrictive and logistically challenging, especially for the patient during transport. Option D reverses the PPE roles, placing the surgical mask on the patient (insufficient for source control) and the N95 respirator on the EMT (appropriate for protection but misaligned with the need to control the patient’s exhalation). The CBIC and CDC guidelines prioritize source control on the patient and respiratory protection for the healthcare worker, making Option C the best fit.

This recommendation is consistent with the CBIC’s emphasis on implementing transmission-based precautions (CDC, 2005, Guideline for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Settings) and the use of PPE tailored to the mode of transmission, as outlined in the CBIC Practice Analysis (2022).