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CBIC Certified Infection Control Exam 認定 CIC 試験問題 (Q168-Q173):

質問 # 168
An infection preventionist is providing education to a group of medical device reprocessing staff on critical steps in cleaning instruments. Which of the following actions is recommended while using washer-disinfector?

A. Disassemble instruments as much as possible
B. Close hinged instruments prior to placing in the machine
C. Use circulating water with a pH of 3
D. Stack instruments inside the machine

正解：A

解説：
Best practices for using a washer-disinfector includedisassembling instrumentsandopening hinged instrumentsto ensure proper cleaning and decontamination.
* TheAPIC Textexplains:
"Open hinged instruments and disassemble all instruments... Confirm that spray will be able to reach all loaded items without impedance."
* This ensures water and detergents reach all surfaces. Avoid stacking instruments and ensure proper placement to allow full cleaning.
References:
APIC Text, 4th Edition, Chapter 108 - Sterile Processing

質問 # 169
What is the limitation of using liquid chemical sterilants to sterilize medical items?

A. It requires a contact time of at least 12 hours.
B. It does not kill the spores.
C. The sterility is not maintained during storage.
D. It can only be used for heat tolerant devices.

正解：C

解説：
The correct answer is B, "The sterility is not maintained during storage," as this represents a key limitation of using liquid chemical sterilants to sterilize medical items. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines and standards from the Association for the Advancement of Medical Instrumentation (AAMI), liquid chemical sterilants, such as glutaraldehyde or peracetic acid, are effective for sterilizing heat-sensitive medical devices by eliminating all forms of microbial life, including spores, when used according to manufacturer instructions (CBIC Practice Analysis, 2022, Domain III:
Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment).
However, a significant limitation is that sterility is not guaranteed after the items are removed from the sterilant and stored, as the sterile barrier can be compromised by environmental contamination, improper packaging, or handling (AAMI ST58:2013, Chemical Sterilization and High-Level Disinfection in Health Care Facilities).
Option A (it does not kill the spores) is incorrect because liquid chemical sterilants are designed to achieve sterilization, including the destruction of bacterial spores, provided the contact time, concentration, and conditions specified by the manufacturer are met. Option C (it requires a contact time of at least 12 hours) is not a universal limitation; while some liquid sterilants require extended contact times (e.g., 10-12 hours for certain formulations), this is a procedural requirement rather than an inherent limitation, and shorter times may be sufficient with other agents or automated systems. Option D (it can only be used for heat tolerant devices) is incorrect because liquid chemical sterilants are specifically intended for heat-sensitive devices that cannot withstand steam or dry heat sterilization.
The limitation of sterility not being maintained during storage underscores the need for immediate use of sterilized items or the use of proper sterile packaging and storage protocols to prevent recontamination. This aligns with CBIC's focus on ensuring the safety and efficacy of reprocessed medical equipment in infection prevention (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment). Healthcare facilities must implement strict post-sterilization handling and storage practices to mitigate this limitation.
References: CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment. AAMI ST58:2013, Chemical Sterilization and High-Level Disinfection in Health Care Facilities.

質問 # 170
Each item or package that is prepared for sterilization should be labeled with the

A. storage location.
B. type of sterilization process.
C. cleaning method (e.g., mechanical or manual).
D. sterilizer identification number or code.

正解：D

解説：
The correct answer is C, "sterilizer identification number or code," as this is the essential information that each item or package prepared for sterilization should be labeled with. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, proper labeling of sterilized items is a critical component of infection prevention and control to ensure traceability and verify the sterilization process. The sterilizer identification number or code links the item to a specific sterilization cycle, allowing the infection preventionist (IP) and sterile processing staff to track the equipment used, confirm compliance with standards (e.g., AAMI ST79), and facilitate recall or investigation if issues arise (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment). This labeling ensures that the sterility of the item can be assured and documented, protecting patient safety by preventing the use of inadequately processed items.
Option A (storage location) is important for inventory management but is not directly related to the sterilization process itself and does not provide evidence of the sterilization event. Option B (type of sterilization process) indicates the method (e.g., steam, ethylene oxide), which is useful but less critical than the sterilizer identification, as the process type alone does not confirm the specific cycle or equipment used.
Option D (cleaning method, e.g., mechanical or manual) is a preliminary step in reprocessing, but it is not required on the sterilization label, as the focus shifts to sterilization verification once the item is prepared.
The requirement for a sterilizer identification number or code aligns with CBIC's emphasis on maintaining rigorous tracking and quality assurance in the reprocessing of medical devices, ensuring accountability and adherence to best practices (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.5 - Evaluate the environment for infection risks). This practice is mandated by standards such as AAMI ST79 to support effective infection control in healthcare settings.
References: CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competencies 3.3 - Ensure safe reprocessing of medical equipment, 3.5 - Evaluate the environment for infection risks. AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in health care facilities.

質問 # 171
Which of the following factors increases a patient's risk of developing ventilator-associated pneumonia (VAP)?

A. In-line suction
B. Acute lung disease
C. Hypoxia
D. Nasogastric tube

正解：D

解説：
Ventilator-associated pneumonia (VAP) is a type of healthcare-associated pneumonia that occurs in patients receiving mechanical ventilation for more than 48 hours. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes identifying risk factors for VAP in the "Prevention and Control of Infectious Diseases" domain, aligning with the Centers for Disease Control and Prevention (CDC) guidelines for preventing ventilator-associated events. The question requires identifying which factor among the options increases a patient's risk of developing VAP, based on evidence from clinical and epidemiological data.
Option B, "Nasogastric tube," is the correct answer. The presence of a nasogastric tube is a well-documented risk factor for VAP. This tube can facilitate the aspiration of oropharyngeal secretions or gastric contents into the lower respiratory tract, bypassing natural defense mechanisms like the epiglottis. The CDC's "Guidelines for Preventing Healthcare-Associated Pneumonia" (2004) and studies in the American Journal of Respiratory and Critical Care Medicine (e.g., Kollef et al., 2005) highlight that nasogastric tubes increase VAP risk by promoting microaspiration, especially if improperly managed or if the patient has impaired gag reflexes. This mechanical disruption of the airway's protective barriers is a direct contributor to infection.
Option A, "Hypoxia," refers to low oxygen levels in the blood, which can be a consequence of lung conditions or VAP but is not a primary risk factor for developing it. Hypoxia may indicate underlying respiratory compromise, but it does not directly increase the likelihood of VAP unless associated with other factors (e.g., prolonged ventilation). Option C, "Acute lung disease," is a broad term that could include conditions like acute respiratory distress syndrome (ARDS), which may predispose patients to VAP due to prolonged ventilation needs. However, acute lung disease itself is not a specific risk factor; rather, it is the need for mechanical ventilation that elevates risk, making this less direct than the nasogastric tube effect.
Option D, "In-line suction," involves a closed-system method for clearing respiratory secretions, which is designed to reduce VAP risk by minimizing contamination during suctioning. The CDC and evidence-based guidelines (e.g., American Thoracic Society, 2016) recommend in-line suction to prevent infection, suggesting it decreases rather than increases VAP risk.
The CBIC Practice Analysis (2022) and CDC guidelines prioritize identifying modifiable risk factors like nasogastric tubes for targeted prevention strategies (e.g., elevating the head of the bed to reduce aspiration).
Option B stands out as the factor most consistently linked to increased VAP risk based on clinical evidence.
References:
* CBIC Practice Analysis, 2022.
* CDC Guidelines for Preventing Healthcare-Associated Pneumonia, 2004.
* Kollef, M. H., et al. (2005). The Impact of Nasogastric Tubes on VAP. American Journal of Respiratory and Critical Care Medicine.
* American Thoracic Society Guidelines on VAP Prevention, 2016.

質問 # 172
Respiratory tract flora are BEST characterized by which of the following statements?

A. Both the upper and lower airways contain small numbers of organisms
B. The upper airway is heavily colonized while the lower airway is not
C. The airway is sterile below the larynx
D. Both the upper and lower airways are sterile throughout

正解：A

解説：
The respiratory tract flora refers to the microbial communities inhabiting the respiratory system, and understanding their distribution is essential for infection prevention and diagnosis. The Certification Board of Infection Control and Epidemiology (CBIC) highlights the importance of microbial ecology in the
"Identification of Infectious Disease Processes" domain, which aligns with the Centers for Disease Control and Prevention (CDC) and clinical microbiology principles. The question seeks the best characterization of respiratory tract flora, requiring an evaluation of current scientific understanding.
Option C, "Both the upper and lower airways contain small numbers of organisms," is the most accurate statement. The upper respiratory tract (e.g., nasal passages, pharynx) is naturally colonized by a diverse microbial community, including bacteria like Streptococcus, Staphylococcus, and Corynebacterium, as well as some fungi and viruses, acting as a first line of defense. The lower respiratory tract (e.g., trachea, bronchi, alveoli) was traditionally considered sterile due to mucociliary clearance and immune mechanisms. However, recent advances in molecular techniques (e.g., 16S rRNA sequencing) have revealed a low-biomass microbiome in the healthy lower airway, consisting of small numbers of organisms such as Prevotella and Veillonella, likely introduced via microaspiration from the upper tract. The CDC and studies in journals like the American Journal of Respiratory and Critical Care Medicine (e.g., Dickson et al., 2016) support this view, indicating that both regions contain microbial populations, though the lower airway's flora is less dense and more tightly regulated.
Option A, "The airway is sterile below the larynx," is outdated. While the lower airway was once thought to be sterile, modern research shows a sparse microbial presence, debunking this as a complete characterization.
Option B, "Both the upper and lower airways are sterile throughout," is incorrect. The upper airway is clearly colonized, and the lower airway, though low in microbial load, is not entirely sterile. Option D, "The upper airway is heavily colonized while the lower airway is not," overstates the contrast. The upper airway is indeed heavily colonized, but the lower airway is not sterile; it contains small numbers of organisms rather than being completely free of microbes.
The CBIC Practice Analysis (2022) and CDC guidelines on respiratory infections acknowledge the evolving understanding of respiratory flora, emphasizing that both upper and lower airways host small microbial populations in healthy individuals. Option C best reflects this balanced and evidence-based characterization.
References:
* CBIC Practice Analysis, 2022.
* Dickson, R. P., et al. (2016). The Microbiome and the Respiratory Tract. American Journal of Respiratory and Critical Care Medicine.
* CDC Principles of Epidemiology, 3rd Edition, 2012.

質問 # 173
......

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