APIC Greater NY Chapter 13 CIC Q&A Review

1. APIC Greater NY Chapter 13CIC Q&A Review April 17, 2019Steven Bock RN CIC FAPIC

2. Q1 A patient is admitted to your medicine unit with a 3 day history of angry red rash to the face, arms, lower legs, and portions of the abdomen and back. Lesions began all about the same time and are pruritic and many are blister-like; some are weeping. The patient has not traveled out of NY in the past 6 months, has had no sick contacts, but did hike in a state park about 5 days ago. Dermatology and ID are consulted. • The patient needs Contact Precautions for the first 24 hours of antibiotic treatment b) The patient may have varicella and requires Airborne and Contact Precautions c) The patient requires no precautions d) Report the patient to the local DOH. There may be additional cases in the community that require a prompt public health response

3. A1 A patient is admitted to your medicine unit with a 3 day history of angry red rash to the face, arms, lower legs, and portions of the abdomen and back. Lesions began all about the same time and are pruritic and many are blister-like; some are weeping. The patient has not traveled out of NY in the past 6 months, has had no sick contacts, but did hike in a state park about 5 days ago. Dermatology and ID are consulted. • The patient needs Contact Precautions for the first 24 hours of antibiotic treatment b) The patient may have varicella and requires Airborne and Contact Precautions c) The patient requires no precautions d) Report the patient to the local DOH. There may be additional cases in the community that require a prompt public health response

4. A1 Rationale A patient is admitted to your medicine unit with a 3 day history of angry red rash to the face, arms, lower legs, and portions of the abdomen and back. Lesions began all about the same time and are pruritic and many are blister-like; some are weeping. The patient has not traveled out of NY in the past 6 months, has had no sick contacts, but did hike in a state park about 5 days ago. Dermatology and ID are consulted. • The patient requires no precautions. Why not? Infectious? Tick borne? Contact Dermatitis (poison ivy) Bonus ? What does the current presenter have on his forearms?

5. Q2 A long-staying ICU patient has an indwelling urinary catheter for more than 7 days when a urine culture reveals 50,000 CFU of E. coli that is resistant to most of the cephalosporins tested. It remains susceptible to Ciprofloxacin and Gentamicin. This organism is an example of: • Methicillin resistance • Aminoglycoside resistance • Extended-spectrum beta-lactam resistance • Quinalone resistance

6. A2 A long-staying ICU patient has an indwelling urinary catheter for more than 7 days when a urine culture reveals 50,000 CFU of E. coli that is resistant to most of the cephalosporins tested. It remains susceptible to Ciprofloxacin and Gentamicin. This organism is an example of: • Methicillin resistance • Aminoglycoside resistance • Extended-spectrum beta-lactam resistance • Quinalone resistance

7. A2 Rationale 50,000 CFU of E. coli … resistant to most of the cephalosporins tested … susceptible to Ciprofloxacin and Gentamicin. • Methicillin resistance • Aminoglycoside resistance • Extended-spectrum beta-lactam resistance • Quinolone resistance ESBLs are Betalactamase producing gram negative bacteria, especially Klebsiella and Escherichia species. ESBLs are enzymes that produce resistance to 1st, 2nd, and 3rd generation cephalosporins. ESBL organisms are often difficult to treat. Bonus ? Was this a CAUTI – if the patient had a fever 2 days before the culture was collected?

8. Q3 All of the following would be considered prevention strategies to reduce the transmission of infections in a healthcare setting, like your hospital or mine, except: • Implementing a mandatory influenza vaccine program for employees • Educating clinical staff members on correct PPE use • Decolonization of MRSA nasal swab positive patients prior to surgery • Instituting use of a sporicidal agent for daily and discharge cleaning of rooms occupied by patients with C. difficile

9. A3 All of the following would be considered prevention strategies to reduce the transmission of infections in a healthcare setting, like your hospital or mine, except: • Implementing a mandatory influenza vaccine program for employees • Educating clinical staff members on correct PPE use • Decolonization of MRSA nasal swab positive patients prior to surgery • Instituting use of a sporicidal agent for daily and discharge cleaning of rooms occupied by patients with C. difficile

10. Q3 Rationale prevention strategies … reduce the transmission of infections … except: • Implementing a mandatory influenza vaccine program for employees – probably helps stop spread of infection • Educating clinical staff members on correct PPE use – probably helps stop spread of infection • Decolonization of MRSA nasal swab positive patients prior to surgery – only affects individual pts, not the spread of infection • Instituting use of a sporicidal agent for daily and discharge cleaning of rooms occupied by patients with C. difficile – probably helps stop spread of infection

11. Q4 Which of the following describes the correct storage to maintain sterility of reprocessed surgical trays? • At least 12 inches from the ceiling, at least 6 inches above the floor, at least one inch from the outside wall, and on a rack with a solid bottom shelf • At least 18 inches from the ceiling, at least 8 inches above the floor, at least 2 inches from the outside wall, and on a rack with a solid bottom shelf • At least 16 inches from the ceiling, at least 8 inches above the floor, at least 1 inch from the outside wall, and on a rack with a solid bottom shelf • At least 18 inches from the ceiling, at least 8 inches above the floor, at least 1 inch from the outside wall, and on a rack with a solid bottom shelf

12. A4 Which of the following describes the correct storage to maintain sterility of reprocessed surgical trays? • At least 12 inches from the ceiling, at least 6 inches above the floor, at least one inch from the outside wall, and on a rack with a solid bottom shelf • At least 18 inches from the ceiling, at least 8 inches above the floor, at least 2 inches from the outside wall, and on a rack with a solid bottom shelf • At least 16 inches from the ceiling, at least 8 inches above the floor, at least 1 inch from the outside wall, and on a rack with a solid bottom shelf • At least 18 inches from the ceiling, at least 8 inches above the floor, at least 1 inch from the outside wall, and on a rack with a solid bottom shelf

13. A4 Rationale Which of the following describes the correct storage to maintain sterility of reprocessed surgical trays? • At least 12 inches from the ceiling, at least 6 inches above the floor, at least one inch from the outside wall, and on a rack with a solid bottom shelf • At least 18 inches from the ceiling, (NFPA fire code) at least 8 inches above the floor, (CMS/TJC – floor mopping splatters…) at least 2 inches from the outside wall, (CMS/TJC – air circulation) and on a rack with a solid bottom shelf (CMS/TJC – floor mopping splatters…) • At least 16 inches from the ceiling, at least 8 inches above the floor, at least 1 inch from the outside wall, and on a rack with a solid bottom shelf • At least 18 inches from the ceiling, at least 8 inches above the floor, at least 1 inch from the outside wall, and on a rack with a solid bottom shelf Bonus ?s What is the HVAC condition for this sterile storage room? Is it OK to have windows or a sink?

14. Q5 You are reviewing a study to assess the association between needleless connector (NC) change frequency and CLABSI rates. In the multivariate analysis, the authors report the CLABSI rate was significantly higher (p=0.001) among patients that had NC changed every 24 hours vs. patients that had NCs changed at 96 hour intervals. As a certified IP, you know that this p value indicates more evidence in support of: • The alternative hypothesis • The quality of the analysis • The null hypothesis • The statistical hypothesis

15. A5 You are reviewing a study to assess the association between needleless connector (NC) change frequency and CLABSI rates. In the multivariate analysis, the authors report the CLABSI rate was significantly higher (p=0.001) among patients that had NC changed every 24 hours vs. patients that had NCs changed at 96 hour intervals. As a certified IP, you know that this p value indicates more evidence in support of: • The alternative hypothesis • The quality of the analysis • The null hypothesis • The statistical hypothesis

16. A5 Rationale assess the association between needleless connector (NC) change frequency and CLABSI rates ... rate was significantly higher(p=0.001) … changed every 24 hours vs. changed at 96 hour intervals. As a certified IP, you know that this p value indicates: • The alternative hypothesis – if the null is not right, the alternative is right, that there is a valid difference between the two groups being compared…the right answer! • The quality of the analysis – sure, the authors are very smart • The null hypothesis – means two groups are the same…null means nothing/no difference • The statistical hypothesis – yup, a p-value means probability, and that means they did some statistical math… BONUS ? What is the minimum for a p-value to be considered significant?

17. THANK YOU! • Now go and take the CIC exam!!