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CBIC Certified Infection Control Exam 認定 CIC 試験問題 (Q103-Q108):

質問 # 103
A team was created to determine what has contributed to the recent increase in catheter associated urinary tract infections (CAUTIs). What quality tool should the team use?

A. Fishbone diagram
B. Gap analysis
C. Plan, do, study, act (PDSA)
D. Failure mode and effect analysis (FMEA)

正解：A

解説：
The correct answer is B, "Fishbone diagram," as this is the most appropriate quality tool for the team to use when determining what has contributed to the recent increase in catheter-associated urinary tract infections (CAUTIs). According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, the fishbone diagram, also known as an Ishikawa or cause-and-effect diagram, is a structured tool used to identify and categorize potential causes of a problem. In this case, the team needs to explore the root causes of the CAUTI increase, which could include factors such as improper catheter insertion techniques, inadequate maintenance, staff training gaps, or environmental issues (CBIC Practice Analysis, 2022, Domain II:
Surveillance and Epidemiologic Investigation, Competency 2.2 - Analyze surveillance data). The fishbone diagram organizes these causes into categories (e.g., people, process, equipment, environment), facilitating a comprehensive analysis and guiding further investigation or intervention.
Option A (gap analysis) is useful for comparing current performance against a desired standard or benchmark, but it is more suited for identifying deficiencies in existing processes rather than uncovering the specific causes of a recent increase. Option C (plan, do, study, act [PDSA]) is a cyclical quality improvement methodology for testing and implementing changes, which would be relevant after identifying causes and designing interventions, not as the initial tool for root cause analysis. Option D (failure mode and effect analysis [FMEA]) is a proactive risk assessment tool used to predict and mitigate potential failures in a process before they occur, making it less applicable to analyzing an existing increase in CAUTIs.
The use of a fishbone diagram aligns with CBIC's emphasis on using data-driven tools to investigate and address healthcare-associated infections (HAIs) like CAUTIs, supporting the team's goal of pinpointing contributory factors (CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competency 2.3 - Identify risk factors for healthcare-associated infections). This tool's visual and collaborative nature also fosters team engagement, which is essential for effective problem-solving in infection prevention.
References: CBIC Practice Analysis, 2022, Domain II: Surveillance and Epidemiologic Investigation, Competencies 2.2 - Analyze surveillance data, 2.3 - Identify risk factors for healthcare-associated infections.

質問 # 104
An infection preventionist (IP) encounters a surgeon at the nurse's station who loudly disagrees with the IP's surgical site infection findings. The IP's BEST response is to:

A. Report the surgeon to the chief of staff.
B. Ask the surgeon to speak in a more private setting to review their concerns.
C. Calmly explain that the findings are credible.
D. Ask the surgeon to change their tone and leave the nurses' station if they refuse.

正解：B

解説：
The scenario involves a conflict between an infection preventionist (IP) and a surgeon regarding surgical site infection (SSI) findings, occurring in a public setting (the nurse's station). The IP's response must align with professional communication standards, infection control priorities, and the principles of collaboration and conflict resolution as emphasized by the Certification Board of Infection Control and Epidemiology (CBIC).
The "best" response should de-escalate the situation, maintain professionalism, and facilitate a constructive dialogue. Let's evaluate each option:
* A. Report the surgeon to the chief of staff: Reporting the surgeon to the chief of staff might be considered if the behavior escalates or violates policy (e.g., harassment or disruption), but it is an escalation that should be a last resort. This action does not address the immediate disagreement about the SSI findings or attempt to resolve the issue collaboratively. It could also strain professional relationships and is not the best initial response, as it bypasses direct communication.
* B. Calmly explain that the findings are credible: Explaining the credibility of the findings is important and demonstrates the IP's confidence in their work, which is based on evidence-based infection control practices. However, doing so in a public setting like the nurse's station, especially with a loud disagreement, may not be effective. The surgeon may feel challenged or defensive, potentially worsening the situation. While this response has merit, it lacks consideration of the setting and the need for privacy to discuss sensitive data.
* C. Ask the surgeon to speak in a more private setting to review their concerns: This response is the most appropriate as it addresses the immediate need to de-escalate the public confrontation and move the discussion to a private setting. It shows respect for the surgeon's concerns, maintains professionalism, and allows the IP to review the SSI findings (e.g., data collection methods, definitions, or surveillance techniques) in a controlled environment. This aligns with CBIC's emphasis on effective communication and collaboration with healthcare teams, as well as the need to protect patient confidentiality and maintain a professional atmosphere. It also provides an opportunity to educate the surgeon on the evidence behind the findings, which is a key IP role.
* D. Ask the surgeon to change their tone and leave the nurses' station if they refuse: Requesting a change in tone is reasonable given the loud disagreement, but demanding the surgeon leave if they refuse is confrontational and risks escalating the conflict. This approach could damage the working relationship and does not address the underlying disagreement about the SSI findings. While maintaining a respectful environment is important, this response prioritizes control over collaboration and is less constructive than seeking a private discussion.
The best response is C, as it promotes a professional, collaborative approach by moving the conversation to a private setting. This allows the IP to address the surgeon's concerns, explain the SSI surveillance methodology (e.g., NHSN definitions or CBIC guidelines), and maintain a positive working relationship, which is critical for effective infection prevention programs. This strategy reflects CBIC's focus on leadership, communication, and teamwork in healthcare settings.
References:
* CBIC Infection Prevention and Control (IPC) Core Competency Model (updated 2023), Domain V:
Management and Communication, which stresses effective interpersonal communication and conflict resolution.
* CBIC Examination Content Outline, Domain V: Leadership and Program Management, which includes collaborating with healthcare personnel and addressing disagreements professionally.
* CDC Guidelines for SSI Surveillance (2023), which emphasize the importance of clear communication of findings to healthcare teams.

質問 # 105
Which of the following represents the most effective strategy for preventing Clostridioides difficile transmission in a healthcare facility?

A. Universal C. difficile screening on admission for high-risk patients.
B. Daily environmental cleaning with quaternary ammonium compounds.
C. Routine use of alcohol-based hand rub for hand hygiene after patient contact.
D. Strict antimicrobial stewardship to limit unnecessary antibiotic use.

正解：D

解説：
* Antimicrobial stewardship is the most effective strategy to reduce C. difficile infections (CDI) by limiting the use of broad-spectrum antibiotics.
* Quaternary ammonium disinfectants (A) are ineffective against C. difficile spores; bleach-based disinfectants are preferred.
* Routine screening (C) is not cost-effective for prevention.
* Alcohol-based hand rubs (D) do not kill C. difficile spores; soap and water should be used.
CBIC Infection Control References:
* APIC Text, "C. difficile Prevention Strategies," Chapter 9.

質問 # 106
Ongoing education for the Infection Preventionist (IP) is MOST important because

A. self-directed learning is not a major force for the adult learner.
B. the healthcare environment is fast-paced with frequent changes.
C. it is necessary to maintain a competitive edge.
D. motivation to change comes from the Management Team.

正解：B

解説：
Ongoing education for Infection Preventionists (IPs) is essential due to therapidly evolving healthcare landscapeand emergence of new infectious diseases, regulations, and technologies.
* From theAPIC Text:
"Professional development is essential to keeping the infection preventionist up to date with the latest knowledge, skills, and strategies for preventing infections."
* TheAPIC/JCR Workbookalso notes:
"Because information related to emerging infectious diseases... changes rapidly... IPs should actively review information for updates and guidance." References:
APIC Text, 4th Edition, Chapter 2 - Competency and Certification
APIC/JCR Workbook, 4th Edition, Chapter 3 - Education and Training

質問 # 107
Working with public health agencies to collect and analyze indicators that might signal an increase in community illness is an example of which type of surveillance?

A. Passive
B. Active
C. Targeted
D. Syndromic

正解：D

解説：
Surveillance is a critical tool in infection prevention and control, used to monitor disease trends and guide public health responses. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes the "Surveillance and Epidemiologic Investigation" domain, which aligns with the Centers for Disease Control and Prevention (CDC) "Principles of Epidemiology in Public Health Practice" (3rd Edition, 2012).
The question describes a process of collecting and analyzing indicators to signal an increase in community illness, requiring identification of the appropriate surveillance type among the options provided.
Option C, "Syndromic," is the correct answer. Syndromic surveillance involves monitoring non-specific health indicators or symptoms (e.g., fever, respiratory complaints, or gastrointestinal issues) that may precede a formal diagnosis, aiming to detect potential outbreaks or increases in community illness early. The CDC defines syndromic surveillance as the real-time or near-real-time collection, analysis, and interpretation of health-related data to provide actionable information, often in collaboration with public health agencies. This approach uses data from sources like emergency department visits, over-the-counter medication sales, or absenteeism reports to identify trends before laboratory confirmation, making it well-suited to the described scenario of signaling community illness increases.
Option A, "Passive," involves healthcare providers or laboratories reporting cases to public health authorities on a voluntary or mandatory basis without active prompting (e.g., routine notifiable disease reporting). While passive surveillance contributes to baseline data, it is less proactive and not specifically designed to signal early increases in illness, making it less fitting. Option B, "Active," entails public health officials actively seeking data from healthcare facilities or providers (e.g., calling to confirm cases during an outbreak). This is more resource-intensive and typically used for specific investigations rather than ongoing community trend monitoring, which aligns better with syndromic methods. Option D, "Targeted," refers to surveillance focused on a specific population, disease, or event (e.g., monitoring TB in a high-risk group). The scenario's broad focus on community illness indicators does not suggest a targeted approach.
The CBIC Practice Analysis (2022) and CDC guidelines highlight syndromic surveillance as a key strategy for early detection of community-wide health threats, often involving collaboration with public health agencies. Option C best matches the described activity of analyzing indicators to signal illness increases, making it the correct choice.
References:
* CBIC Practice Analysis, 2022.
* CDC Principles of Epidemiology in Public Health Practice, 3rd Edition, 2012.
* CDC Syndromic Surveillance Systems, 2020.

質問 # 108
......

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