ONLINE EXAMINATION PAPER
Date: Friday, 27 August 2021
Time: 10:30 - 12:30 Hours
Duration: 2 Hours
INSTRUCTIONS TO CANDIDATES
- This online quiz contains 100 questions divided into 20 pages, excluding this cover page.
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1.
Mr Lim was diagnosed with chicken pox during admission. Which precautions should be taken during his hospitalization?
2.
A 68 year-old man underwent insertion of dynamic hip screw after suffering a fracture of his femur. He came back a month later, complaining of pain in his upper thigh, associated with swelling and a small amount of purulent discharge. X-rays showed that there is loosening of the screw, and ultrasound revealed fluid collection around the hip joint. As part of your SSI surveillance, you would mark this as
3.
The nurses in the Endoscopy Unit reported that several patients had called to indicate they had become ill with fever and diarrhoea after their colonoscopy procedure. The Endoscopy staffs were concerned. Upon review, you determined that the patients did have infections and decided to begin an outbreak investigation. At this point, your next step would be to
4.
A patient transferred into an acute care hospital from a nursing home is diagnosed to have norovirus gastroenteritis. As the infection prevention & control nurse of the acute care hospital, what would you do next?
5.
When evaluating a product, the most important question to answer is whether
6.
A patient with renal transplant done 2 years ago was admitted to your facility. The physician is worried and wanted to put this patient in a protective environment (PE) room. He sought your help in getting this room for his patient. What would be the appropriate actions that you should take next?
7.
You were informed that one of the residents in a nursing home is suspected to have active TB. The facility does not have a negative pressure room. You will advise that
8.
Multiple positive blood cultures of which of the following organisms would lead you to suspect an outbreak of contaminated fluid infusions?
9.
A 30-yearold nurse was exposed to a patient confirmed to have measles. She is 20 weeks pregnant. She did not recall having measles or receiving measles vaccination previously. The post-exposure management should include:
10.
Mdm Lee was isolated for her Vancomycin Resistance Enterococcus status with diarrhoea. Nurse Tan was about to administer intravenous therapy for her. Which personal protective equipment should she don?
11.
For the prevention of transmission of invasive meningococcal disease in an acute care hospital, which of the following should be instituted?
12.
You received a call from Haematology Ward nurse manager informing you that 3 patients in her ward were found to have Aspergillus growth in their blood. All of them had stayed in the ward for more than a month before they became septic and blood culture was done to rule out the cause of the sepsis. They had been transferred to ICU single rooms due to their worsening medical conditions. As an Infection Prevention professional, what will be your immediate action?
13.
A patient who presents to you with watery diarrhea relates a history of having consumed some oysters and a variety of other seafood at a famous oyster bar 24 hours prior to the onset of symptoms. Your suspicion for the most likely causative organism is:
14.
An unbooked pregnant woman was admitted to hospital in labour. Her blood tested positive for HBsAg. To best prevent transmission of hepatitis B virus to her baby, the following measure(s) are required:
15.
You observed that an occupational therapist has just completed in assisting a patient in the finger exercises. She did not perform any hand hygiene. She proceeded to the next patient to assist him in exercising his right arm. How should you record your observations?
16.
How would you interpret the below results?
A 34-year old female presented with signs and symptoms of a urinary tract infection. The result of the mid-stream urine culture collected from this patient is as follows:
Urine microscopy: Bacteria ++
Leucocytes ++
Growth of Escherichia coli
Viable count >100,000 cfu/ml
Ampicillin R
Amoxycillin-clavulanate S
Ciprofloxacin S
17.
You were informed of a newly diagnosed Legionella infection in a patient who had been staying in the general ward for close to a month. What would the next appropriate action to take?
18.
From the provided antibiotype information below, choose the most accurate statement.
The following antibiogram is available for two Pseudomonas aeruginosa (PSAE) isolates.
| | PSAE 1 | PSAE 2 |
| Ampicillin | R | R |
| Ciprofloxacin | S | S |
| Augmentin | R | R |
| Trimethoprim | R | R |
| Gentamicin | S | S |
| Imipenem | S | S |
19.
You are conducting an inspection of a renovation site in a ward and you meet the ward nurse manager near the worksite. Double layers of plastic sheets had been put up for hoarding purpose. You take the opportunity to share with her the importance of inspection which includes following points except:
20.
You need to explain to your team on the need to collaborate in the patient safety walkabout. Which is the best statement?
21.
To report healthcare onset MRSA infection, it is best to plot the data as
22.
In the example below, where mechanical ventilation (MV) days are shown with the daily minimum PEEP and daily minimum FiO2 for an intubated patient, which statement is true?
| MV Day | Daily minimum PEEP (cmH2O) | Daily minimum FiO2 (oxygen concentration, %) |
| 1 | 0 | 1.00 (100%) |
| 2 | 0 | 0.50 (50%) |
| 3 | 3 | 0.50 (50%) |
| 4 | 5 | 0.50 (50%) |
| 5 | 8 | 0.50 (50%) |
| 6 | 8 | 0.50 (50%) |
23.
Student Nurse Ong was informed by her senior nurse to serve bedpan to Mdm Yap in Room 8 who was newly diagnosed with MRSA in her sputum. Unfortunately, there was no precaution signage on the door. Which is/are the correct precautions she should apply?
24.
A watery stool specimen was sent to the laboratory for confirmation of Clostridium difficile in a symptomatic patient. The results are:
- GDH positive
- Toxin A/B negative
The most appropriate action to be taken is
25.
You audited the kitchen and noticed that the temperature of the freezer and the dish washing were out of range. The checklist consisted of 32 care elements. What is the compliance rate for the kitchen?
26.
A pregnant woman in her 24th week of gestation consulted her obstetrician immediately after her 4-year old son was diagnosed with chickenpox. She does not know if she had chickenpox or received the varicella vaccine before. What should her obstetrician do?
27.
There is an outbreak of carbapenemase producing Enterobacterales (CPE) in several wards in your hospital. As part of outbreak investigation, you are tasked to screen patients and the environment for CPE. An estimated 80 samples are to be collected over 2 days. Your next action is to:
28.
Success in the implementation of guidelines is determined mainly by
29.
You are giving recommendations to the Facility Manager on dust containment measures for an upcoming renovation project. Which of the following should be included?
30.
A patient was recently diagnosed to have CJD. The medical staff had earlier taken CSF samples for investigation. You received a call from the laboratory as they were anxious that their staff had been exposed to CJD whilst processing CSF samples e.g. microscopic examination. How would you advise the laboratory?
31.
With respect to VAE surveillance, from the table below, if the patient is intubated at 4 pm, what is the daily minimum FiO2?
| Time | 4pm | 5pm | 5.30pm | 6pm | 8pm | 9pm | 10pm | 12am |
| FiO2 | 1.0 | 0.60 | 0.3 | 0.6 | 0.40 | 0.50 | 0.55 | 0.60 |
32.
Ms Ong, an Infection Prevention nurse is involved in a workgroup that helps to set up a new hospital. She planned to create a surveillance system to monitor the healthcare associated infection rates and submit indicators to MOH. Which approach should she consider?
33.
You have been appointed as the Infection Prevention & Control Officer in a newly built acute tertiary care hospital and setting up an Infection Prevention & Control Team. Which of the following candidate will you select for the post of senior Infection Prevention & Control Nurse?
34.
An incident involves data at 2 standard deviation more than the usual monthly number of MRSA cases, but are either not epidemiologically linked or awaiting epidemiological investigations for confirmation of links. What is this called?
35.
A patient developed MRSA bacteremia following the insertion of a central line. In your investigation, you found out that the staff used 0.05% CHG as skin disinfectant because the patient had a very bad skin condition and she did not want to cause further skin irritation. What immediate steps would you take next?
36.
When choosing a cleaning product for the environment cleaning which of the following should be considered?
37.
The Infection Prevention & Control nurse has identified a group of patients who have become infected following a surgical procedure. He wants to review the risk factors of those who are infected and those who had the same procedure and did not get an infection. Which method is most likely to help him quickly analyse the risk factors and accomplish his goal?
38.
In your briefing to the new CEO of your hospital, as the Head of the Infection Prevention & Control Team, you would want to include the following in your summary of the work of the department:
39.
If you introduce chlorhexidine bath in the ICU, which device-associated infection(s) will likely be reduced?
40.
Before preparing teaching plan to a group of health care workers on infection prevention and control it is necessary to do the following:
41.
A medical officer had intubated a collapsed 65 year-old man without using a surgical mask. N. meningitidis was subsequently isolated in his endotracheal secretions. How should the healthcare workers exposed to this patient be managed?
42.
You are tasked to set up an infection prevention program in an ambulatory practice, which provides primary health care to a semi-urban community. Which first step would you take to set up this program?
43.
A microbiologist was doing a study on molecular types of CP-CRE and informed you of a few patients with similar PFGE type and he suspected that there is an early sign of an outbreak. What would be your response?
44.
You have collated a total of 50 care element during your audit. You realised that there
45.
A CSSD staff noticed that tapes on instrument packages did not have visible lines indicating completed sterilization process. She informed her supervisor who then consulted you regarding course of actions. What would you recommend?
46.
In trying to institute a program to stop an outbreak of drug-resistant hospital bacteria (spread mainly via contact with healthcare staff and the environment) in your institution – a tertiary hospital with multiple specialty practices under one roof – which of these measures would you not implement initially?
47.
An excited doctor has just informed you that he had just seen 5 patients with Pseudomonas aeruginosa resistant to Imipenem in 3 separate wards in the hospital. He thinks that this is an outbreak and requested you to investigate this further. From the above information given, you would do the following:
48.
Nurse Lee was guiding nurse Tan, a newly appointed Infection Prevention Liaison Officer in defining a healthcare associated infection. What should Nurse Lee emphasize to nurse Lee?
49.
Mrs Panicker has poorly controlled diabetes mellitus, and is admitted for abdominal pain thought to be due to gallstones. For her scheduled cholecystectomy, her risks of post-op surgical site infection are:
51.
Escherichia coli (E.coli) is a common commensal bacterium in humans. Which of the following clinical scenarios clearly indicates infection with E. coli?
52.
You note special cause variation in the VAP rate in the MICU. You would then proceed to
53.
You had just completed an audit at the Endoscopy Centre. You checked the air supply indicator. What should the air changes per hour (ACH) reading be to meet the required standard?
54.
Ventilator associated pneumonia prevention bundles will typically include all of the following except
55.
The audit was carried out in one of the food stalls in the cafetaria. You are required to audit 48 care elements and the stall only scored 35.42%. How many of the elements are non-compliance?
56.
Nurse Lee was clearing the IV chemo bags after the infusion has completed. When she went into the disposal room there are many different coloured bags. Which bag should be pick?
57.
A patient is placed on contact precautions for an infection with a resistant organism. You notice the patient seems to be depressed and withdrawn. The best intervention is to:
58.
Ms Poh was informed by Nurse Chong to perform terminal cleaning for a room that was previously occupied by a patient with Candida auris. Which of the following disinfectant should she be using to do this effectively?
59.
You wanted to reduce healthcare associated MRSA infections in your facility. Your next action is to
60.
Ward ABC had a total of 235 opportunities observed which comprised 55 alcohol based handrub, 35 hand washing and the rest no hand hygiene. What is the non-compliance rate?
61.
Staff Nurse Wong drew 6 units of Actrapid (insulin) from a multi-dose vial and administered it to Patient A. Patient B who was just admitted in the next cubicle to patient A, was diagnosed with DKA (Diabetic Ketoacidosis) with blood sugar level of 22 mmol/L. The doctor on-call instructed you to draw 10 units Actrapid (belongs to patient A) and administer to patient B. What should SN Wong do?
62.
You are recommending that the hospital purchase a safety device to reduce needlestick injuries. The CEO is likely to support your proposal if you
63.
A bacterial culture result reads “Coagulase negative Staphylococcus (Staphylococcus epidermidis) isolated”. How would you interpret this result?
64.
Nurse Lee was going to inform the housekeeper to clean a room that was previously occupied by a patient with known Clostridium difficile. Which of the following disinfectant should the housekeeper use?
65.
You are asked to prepare a hospital laundry guideline on handling of soiled linen. Some important factors to include are
66.
In an influenza pandemic,
67.
A nurse was called to attend to an inpatient with confirmed influenza. She had been immunized with the latest recommended seasonal influenza vaccine. Which of the following is not needed?
68.
A 25-year old sportsman is involved in a road-traffic accident. He suffers chest contusion and abdominal injuries requiring emergency laparotomy. For your surveillance purposes, you would mark this as a
69.
Given the scenario below, the likely causative organism could have been:
You are a volunteer working for a non-profit organization in Indonesia when you are approached for help in investigating a large outbreak of diarrhea in a rural community close to you.
Upon speaking to the locals, you discover that they had all attended a wedding recently and you suspect that there could have been a common point source contamination at the event. On further interviews, you discover that the cook, a 40-year old woman had diarrhea, which had developed a day prior to the event, but because she did not feel too unwell, continued to cater for the event.
In trying to characterize the features of the outbreak to determine the possible causative organism you find that:
- Everyone fell sick with diarrhoea and fever within 2-3 days of the event, indicating a short incubation period
- Large numbers were affected, nearly all 60 guests that attended.
- A large number of household members who had NOT attended the event (secondary contacts) also developed the illness.
- Most had recovered from the illness within 3 days.
The likely causative organism could have been:
70.
The Head of the Haematology Unit tells you that he is seeing a lot more MRSA cases than normal. You would then
71.
A doctor completed his task in inserting a peripheral intravenous line for a patient in single room during your hand hygiene auditing. Your saw him removed his gloves and performed hand hygiene. He left the patient room and closed the door behind him. However, he forgot to perform hand hygiene after closing the patient’s room door in your observation. How many opportunities were there?
72.
Given the case below, what is your next step in his management?
A 58-year old man presents to the emergency department with fever and dysuria of 4 days onset. He is examined by the medical officer, where a digital rectal exam revealed an enlarged prostate, and urinalysis is consistent with a diagnosis of urinary tract infection. He is given a 10-day course of oral Ciprofloxacin and discharged home.
Four days later, he returns with abdominal distention and diarrhea. You suspect that he could have Clostridioides difficile infection as a consequence of antimicrobial therapy.
You send off an EIA test for Clostridioides difficile, and the results are as shown:
| Clostridium difficile Antigen | Detected |
| Clostridium difficile Toxin | Not detected |
What is your next step in his management?
73.
A microbiological surveillance from the Endoscopy Centre showed Moraxella catarrhalis was isolated from post-reprocessing sample. The Endoscopy Centre staff contacted you and alerted you of this result. How would you advise the staff?
74.
If you were planning an intervention to reduce central venous catheter bloodstream infections in your ward, which of the following would be the best way to collect baseline data on infections in your ward?
75.
With regards to IPC governance and management in ILTC,
76.
You went with the Environmental Services to perform an audit. Your team discovered the window sill and air-vent were dusty. How many non-compliances will you record?
77.
To get buy-in from doctors, one can
78.
A staff has reported having bacterial gastroenteritis. She works in the paediatric ward, and her symptoms have resolved. Other than encouraging strict adherence to hand hygiene at all times, you also recommend:
79.
A truly random sample of the general population would be obtained by
80.
Mr Gopal, with no medical conditions or allergies, is planned for surgery on his spine with insertion of screws and bone graft. The list is scheduled for 1 August at 2pm. The correct statement with regards to antimicrobial usage for him is:
81.
The Medical ICU Director is keen on reducing ventilator associated pneumonia in his unit. He consulted you and said that he thinks the oral hygiene program is not well implemented. He wanted the patients to be on a strict regime of oral toilet 6 times a day instead of usual 3 times a day. What would your response be?
82.
You observed a nurse check on a patient central line site followed by draining his urine from the drainage bag. How many opportunities were observed?
83.
A parent had a sick child at home and in the hospital. How would you advise her?
84.
In the education program on appropriate patient care practices, an effective strategy will be to
85.
Your hospital sees about 2-3 possible VAPs (PVAPs) a month in the surgical ICU. Recent surveillance showed that there were 4 PVAPs in this ICU. The Chairman of the Infection Prevention & Control Committee commented that this is a ‘significant’ increase from the usual. What would you advise him?
86.
A previously healthy 20-year old full-time military service man was admitted to the ward with fever, confusion and a cellulitis of the lower limb. Blood cultures grew an organism that formed beta-haemolytic colonies and showed Gram-positive cocci in chains on staining. Which of the following is the most appropriate combination of likely organism and Infection Prevention measure you should implement?
87.
Given the case below, which of the below is/are true:
A 35-year-old Malaysian Medical Officer had sustained a needlestick injury over his left index finger as he was stitching a laparotomy wound in Major OT 3 days ago. He was using double gloves at that time. He had recalled receiving Hepatitis B vaccine (3 doses) dur ing medical school. No post vaccination Hepatitis B antibody was checked.
His serology results: HBsAg, Hep C (EIA) and HIV screen antibody were nonreactive. Anti HBs < 10 mIU/mL.
The source patient serology results: HBs Ag positive, Hep C (EIA) and HIV screen was negative.
He has now presented at the Needlestick Injury Clinic for assessment.
Which of the following is/are true:
88.
You have been asked to design a waste management program for an intermediate long-term care /community hospital. Which of the following steps would you initiate first?
89.
In the use of guidelines
90.
Which would be the best approach to use when conducting education to a group of healthcare workers’
91.
Ms Ng is planning a program to conduct environmental cleaning audit to ensure that effective cleaning has been carried out by the housekeeper. Which is the most cost-effective method for audit?
92.
You were informed by CSSD regarding a failed biological indicator (BI) test. What would you advise?
93.
Read the case below and identify what is the likely cause of fever and what is the next course of action?
A 88 year old male patient (57kg) with Bactrim allergy (facial rash with urticaria)had the following past medical history: Diabetes mellitus, Hypertension, Hyperlipidemia, CKD stage 5 (decline dialysis), IHD s/p CABG 2010, Gout, sick sinus syndrome s/p pacemaker insertion.
He had no recent hospitalization and currently admitted for giddiness and lower limb weakness
Patient is being worked up for benign paroxysmal positional vertigo (BPPV) and possible stroke. On day 3 of admission, patient developed fever (Tmax 38.5oC), and complains of swollen right ankle resulting in pain on ambulation. Patient was started on IV Piperacillin-tazobactam 4.5g Q6h for fever likely secondary to healthcare associated infection (HAI).
On examination, the right ankle was swollen with increased warmth but no overlying erythema.
Mild tenderness on palpation along ankle joint, some crepitus noted on passive extension and flexion of right ankle joint.
Chest X-ray: no consolidation
Left hand plug: intact, no phlebitis
Laboratory markers done on day of fever:
Procalcitonin (PCT) 0.50 ug/L
C-Reactive Protein (CRP) 205 mg/L
Total White Cell Count (TW) 10.5 x 109 cells/L
Serum creatinine (Cr) 320umol/L
What is the likely cause of fever and what is the next course of action?
94.
To ensure the success of the Infection Prevention & Control program in your institution, it is critical to have
95.
In the surveillance of an infection prevention indicator, when would data validation be required?
96.
Ms Tan was informed by her supervisor to perform drying and ironing after washing the linen. What would be the best rationale that the supervisor can use to help explain why Ms Tan should proceed to drying and ironing after washing?
97.
The data points in the control chart of surgical site infections demonstrate steadily increasing data point values over Jan-Sep 2018. You would therefore report this as a
98.
An Orthopedic Medical Officer was accidentally injured by a drill bit during an internal fixation of a fractured femur in a HIV positive patient (currently on ART) this morning. What post-exposure prophylaxis would you recommend for this doctor?
99.
Patient A develops anaphylactic shock with administration of penicillin. Which of the following antibiotics is not safe to administer to Patient A?
100.
You noticed that the hospitalwide CAUTI rates have been increasing in last 4 months. Your next immediate action step would be:
