11th APSIC Training Course Examination

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.
You are required to log in to Zoom and turn on your camera throughout the period of the exam.
The IP Address of the ZOOM login and the IP Address for submission of your examination paper will be captured by our system to ensure that you are the one who have submitted the paper.
You are encouraged to click on "Save Quiz" regularly so that you will not lost your answers entered. A Session ID will be displayed each time you save your quiz. Please keep the ID well as you will need this ID to resume your partially completed examination paper.
For some reasons if you are logged out of the internet and need to resume your quiz, enter the URL given to you and click on "Load Quiz". You will be prompted to enter your Session ID. Enter the session ID you have saved and you will be able to resume your quiz from where you last worked on.
Please enter your registered name and email address below.

Name

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?

>10

Ventilator associated pneumonia prevention bundles will typically include all of the following except

Elevation of the head of the bed 30-450

Regular change of the ventilator circuit every 3 days.

PUD prophylaxis.

DVT prophylaxis.

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?

wearing a mask when entering the patient’s room

wearing gloves and performing hand hygiene after removing them afterwards

wear a gown and remove it before leaving the patient’s room

none of the above

If you introduce chlorhexidine bath in the ICU, which device-associated infection(s) will likely be reduced?

Ventilator associated pneumonia

Catheter-associated urinary tract infection

Catheter-associated bloodstream infection

Surgical site infection

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

Superficial Incisional SSI

Deep Incisional SSI

Organ/Space SSI

Not infected

The Head of the Haematology Unit tells you that he is seeing a lot more MRSA cases than normal. You would then

Construct a control chart to look for special cause variation.

Do a root cause analysis to determine key contributing factors.

Plan for a failure mode effects analysis to look for probable causes.

Plot a bar chart to determine patterns in incidence amongst MRSA cases.

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:

Proceed to perform a cohort study of the 3 patients

Do nothing because it occurred in different locations

Check with the Microbiology Laboratory on the antibiotic susceptibility results

Close the 3 wards because these are virulent strains

To ensure the success of the Infection Prevention & Control program in your institution, it is critical to have

Trained Infection Prevention & Control Committee members

Good collaboration with the Quality Department

Leadership support of the Infection Prevention & Control Department

Integrated IT system to support surveillance plans

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?

38.30%

23.50%

61.70%

76.59 %

10.

When evaluating a product, the most important question to answer is whether

It is clinically proven with good published evidence.

Staffs like the product and are happy to use it.

One can easily reprocess it safely or clean adequately.

It is line with the institution’s priorities and goals.

11.

Which would be the best approach to use when conducting education to a group of healthcare workers’

Have background music, allow participants to use their mobile phone and motivate participants

Tell the participants your expectation, conducive environment and give them the options of taking exam at the end of the teaching session

Conducive environment, use a wide variety of instruction methods and motivate the participants

Provide short breaks after every half an hour, use one type of teaching instruction and provide a conducive environment

12.

For the prevention of transmission of invasive meningococcal disease in an acute care hospital, which of the following should be instituted?

Airborne precautions for the first 24 hours after starting appropriate antimicrobials and meningococcal conjugate vaccination for the exposed health care workers.

Contact precautions for the total duration of the antimicrobial therapy and antibiotic chemoprophylaxis for all exposed health care workers.

Airborne precautions for the first 72 hours after starting appropriate antimicrobial.

Droplet precautions for the first 24 hours after starting appropriate antimicrobials and antibiotic chemoprophylaxis for the healthcare workers who were directly exposed to the patient’s oral secretions.

13.

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?

Watch and wait as it is too early to tell.

Agree with him and recommend an investigation.

Advise that he talks to the ICU Director.

ICU nurses’ input is required on ETT care.

14.

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

0.30

0.55

0.50

0.40

15.

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

The viable count of >100,000 cfu/ml indicates contamination of this urine sample.

Ampicillin could be used for treatment of this urinary tract infection.

The presence of pyuria is consistent with a urinary tract infection.

Escherichia coli is an uncommon cause of community-acquired urinary tract infection.

16.

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%)

The patient has a ventilator associated event (VAE) on MV Day 2.

The patient has a ventilator associated event (VAE) on MV Day 3.

The patient has a ventilator associated event (VAE) on MV Day 4.

The patient has a ventilator associated event (VAE) on MV Day 5.

17.

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?

It removes substantial quantity of micro-organisms from the linen

It suspends soils, removes foreign substances (including microbes) and destroys micro-organisms

It destroys micro-organisms at target of achieving total available chlorine residual of 50 to 150ppm

It will minimize microbial re-contamination during handling due to high temperature used.

18.

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?

Isolate him immediately and institute strict precautions by all staff.

Wait for a second case before you declare a norovirus outbreak to the hospital.

Look for source of norovirus amongst the surrounding inpatients in the cubicle.

Alert the nursing home to look out for residents with norovirus infection.

19.

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:

Give the baby hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth

Give the baby hepatitis B vaccine within 12 hours of birth and hepatitis B immune globulin 1 month later

Give the baby hepatitis B vaccine at birth; hepatitis B immune globulin is not necessary

Give the baby hepatitis B immune globulin at birth; hepatitis B vaccine is not necessary

20.

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:

Salmonella typhi

Staphyloccocus aureus

Vibrio parahaemolyticus

Rotavirus

21.

You noticed that the hospitalwide CAUTI rates have been increasing in last 4 months. Your next immediate action step would be:

Check on compliance with insertion and maintenance bundles in wards with high rates

Prepare a paper to propose the use of antimicrobial impregnated catheters to help reduce the rates

Continue to monitor as there are too few data points to conclude that this is a significant change

Confirm with MMD that all urinary catheters procured has a sampling port to exclude sampling error

22.

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?

Re-assure her that this is a skin commensal and hence, there is no need to worry

Check on method that she used in collecting the sample as you suspect contamination may have occurred during sample collection

Get her to re-process all affected endoscopes as you suspect inadequate reprocessing from the above result

Inform her that this is not a significant result and so, no further action is required from the staff at Endoscopy Centre

23.

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

Shift

Random variation

Trend

Special cause variation

24.

You are recommending that the hospital purchase a safety device to reduce needlestick injuries. The CEO is likely to support your proposal if you

Have demonstrated that you are an expert as evidenced by many publications to your name.

Highlight the potential cost benefit analysis associated with its implementation.

Indicate that yours is the only hospital in the country that has yet to implement the practice.

Present your proposal using latest video technology and evidence from literature.

25.

To report healthcare onset MRSA infection, it is best to plot the data as

Stacked bar chart showing the breakdown by infection and colonization.

Line chart of MRSA infections by departments.

Pie chart showing various sites of infection.

Either a ‘u’ or ‘c’ control chart.

26.

In an influenza pandemic,

Spread of the virus in a community can be prevented via quarantine of contacts and isolation of infected cases.

Use of oseltamivir as ring prophylaxis may protect persons living in institutions such as nursing homes and military camps.

Mass vaccination with the existing influenza vaccine may prevent spread of the virus in a community.

PCR testing should be performed on all persons meeting the case definition for influenza.

27.

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:

Vaneometer is used to indicate the air flow direction

Dust mat is clean

Entrance to the worksite is kept closed at all times

Hoarding is dust-tight

28.

With regards to IPC governance and management in ILTC,

A dedicated IPC personnel responsible for implementation and execution of the IPC programme in a nursing home are usually staff with a rehabilitation qualification.

ILTC sector in Singapore is exempted from monitoring IPC process and outcomes through surveillance and auditing.

Support from leadership and IPC committee is required for the implementation and execution of IPC program by IPC personnel.

Representative members of IPC Committee shall include Food Service, Maintenance, Housekeeping and Finance Staff.

29.

Mr Lim was diagnosed with chicken pox during admission. Which precautions should be taken during his hospitalization?

Droplet precautions

Contact precautions

Airborne & contact precautions

Droplet & contact precautions

30.

A parent had a sick child at home and in the hospital. How would you advise her?

No child with fever or symptoms of acute infection e.g. URTI, GE, infectious rash should be allowed to visit.

Siblings recently exposed to person with contagious infection and are susceptible are not allowed to visit.

Visiting sibling may visit his sibling and the other patients in the same cubicle.

Sibling visit should be supervised by parents and limited to patient’s room/ other designated area.

31.

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?

93.75%

6.25%

16%

10.6%

32.

Patient A develops anaphylactic shock with administration of penicillin. Which of the following antibiotics is not safe to administer to Patient A?

Ciprofloxacin

Aztreonam

Piperacillin/tazobactam

Clarithromycin

33.

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?

Launch an antimicrobial stewardship program to reduce inappropriate antibiotic prescriptions.

Put in a plan to isolate positive and high-risk patients (separately) during their hospital stay.

Get the hospital CEO and specialty chiefs to publicly announce their support for your program.

Educate hospital staff and infected/colonized patients about this outbreak and the measures that are taken to control it.

34.

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:

Cryptosporidium

Nontyphoidal Salmonella

Shigella

Campylobacter

35.

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?

2 indications and 2 opportunities

2 indications and 1 opportunity

3 indications and 2 opportunities

3 indications and 3 opportunities

36.

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?

2 opportunities

1 opportunity

3 opportunities

0 opportunity

37.

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?

A cluster

An outbreak

An occurrence

All of the above

38.

You were informed by CSSD regarding a failed biological indicator (BI) test. What would you advise?

CSSD supervisor to report to Medical Director regarding incident

Trace back immediately all patients who had used the instrument packs processed by affected load and then inform Medical Director regarding the incident

CSSD supervisor to recheck with another BI to see if this is a false positive

Check with Patient Safety regarding whether there is a need to inform affected patients regarding incident at CSSD

39.

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?

Sodium hypochlorite 500ppm

Sodium hypochlorite 5000ppm

Sodium hypochlorite 100ppm

Sodium hypochlorite 1000ppm

40.

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?

41.

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?

Truvada plus Raltegravir to be started immediately.

Combivir to be started immediately.

Truvada plus Raltegravir to be started the next day.

Combivir to be started the next day.

42.

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?

Find out more on why the patient is re-admitted to understand the patient’s status

Check on patient’s white cell count and then decide whether he is eligible for a PE room

Gently tell him that a PE room is meant only for haematology patients.

Discuss with physician to understand his real concern on IPC issues for this patient

43.

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?

Green coloured bag

Purple coloured bag

Orange coloured bag

Yellow coloured bag

44.

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?

Surgical mask and gown

N95 mask

Surgical mask

Gown and gloves

45.

Escherichia coli (E.coli) is a common commensal bacterium in humans. Which of the following clinical scenarios clearly indicates infection with E. coli?

Microbial growth of E. coli from stool culture taken from in a patient with gastroenteritis.

Microbial growth of E. coli from blood culture collected from a patient with pyelonephritis.

Microbial growth of E. coli from raw minced meat.

Microbial growth of E. coli from a foot swab taken from a patient with appendicitis.

46.

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?

Draw 10 units of Actrapid that belongs to patient A using the same syringe and a new needle and administer to patient B

Draw 10 units of Actrapid that belongs to patient A using a new needle and new syringe, and administer to patient B

Inform doctor to best order a new vial of Actrapid dedicated only for patient B, without sharing the same vial between patients in the patient area

Pass the Actrapid vial that belongs to patient A, a new needle and syringe to doctor and leave the scene.

47.

You note special cause variation in the VAP rate in the MICU. You would then proceed to

Start a quality improvement project to improve

Conduct a root cause analysis to solve the problem

Pay special attention to the monitoring of this indicator

Alert the MICU staff to comply with the VAP Bundle

48.

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?

An ICU trained nurse with Masters in Public Health degree.

A nurse with 5 years working experience in the operating theatre.

A trained Infection Prevention & Control Nurse with 4 years working experience.

A nurse recently trained in Infection Prevention & Control with experience in administration.

49.

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:

She wears a gown and gloves for routine patient care for 2 weeks.

A negative stool culture before returning to work.

She undergoes vaccination for Hepatitis A.

She should be assigned to non-clinical duties for 2 weeks.

50.

When choosing a cleaning product for the environment cleaning which of the following should be considered?

Approval by environmental services, facilities team and MMD (Material Management department).

Approval by environmental services, infection prevention and control and occupational health and safety.

Do not need to use according to the manufacturer’s recommendations.

Approval by environmental services, facilities team and occupational health and safety.

51.

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

Put the patient on contact isolation as this is C difficile diarrhoea and highly contagious.

Continue standard precautions as the patient is negative for C difficile.

Send the specimen for a PCR test to confirm the presence of C difficile.

Send another stool specimen for testing.

52.

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?

Develop an overall plan for waste disposal

Make sure the organization has adequate biohazard bags.

Find out about national infectious waste regulations

Conduct an in-service on waste disposal for the staff.

53.

You are asked to prepare a hospital laundry guideline on handling of soiled linen. Some important factors to include are

Soiled linen should be handled with minimum agitation.

Soiled linen should be bagged at the location where it was used.

Soiled linen should be transported in bags that prevent leakage.

All of the above.

54.

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?

Sodium hypochlorite 1000ppm

Quaternary ammonium

Sodium Hypochlorite 5000ppm

Household detergent

55.

Multiple positive blood cultures of which of the following organisms would lead you to suspect an outbreak of contaminated fluid infusions?

Staphylococcus aureus

Coagulase negative Staphylococcus

Enterobacter agglomerans

Escherichia coli

56.

You need to explain to your team on the need to collaborate in the patient safety walkabout. Which is the best statement?

The patient safety walkabout team will get to know each other better.

The benefit for the walkabout team is to have a team approach in solving problems and issues.

The walkabout is conducted once a month only,

The walkabout team involves various stakeholders and is the best approach.

57.

A truly random sample of the general population would be obtained by

Selecting an individual from every 4th bed in the ward.

Taking every odd numbered patient that comes along.

Choosing every 10th individual from a list of patients.

Getting the computer to generate numbers for selection.

58.

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:

Lower the lighting and reduce noise to calm the patient.

Reduce the level of precautions to permit greater interaction with the patient.

Explain the reason for contact precautions and answer the patient's questions.

Limit family and other caregiver visits to reduce the risk for spreading the infection.

59.

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:

Reduced if she can have good post-operative glucose control.

Reduced if she received broad-spectrum antibiotics.

Increased if she has poor pain control.

Greater if she delays her surgery.

60.

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?

A one day point prevalence survey.

A one week review of lab reports of positive blood cultures.

A one month prospective collection of blood cultures in patients with central lines.

A six month review of all discharge summaries of patients from your ward.

61.

You have collated a total of 50 care element during your audit. You realised that there

14%

86%

100%

62.

In the use of guidelines

Equal attention and educational efforts should be given for all the recommendations in the guideline.

The use of the flowchart format is shown to be most effective.

The baseline compliance rates before implementation is needed only if there no time to conduct proper education.

The first step in implementation is to evaluate and format the guideline according to the local needs of the hospital.

63.

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:

MMR vaccination (2 doses 4 weeks apart).

Administer normal human immune globulin as soon as possible.

MMR vaccination and normal human immune globulin.

Exclusion from nursing duties until 21 days after the exposure.

64.

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?

2 opportunities.

1 opportunity.

3 opportunities.

0 opportunity.

65.

To get buy-in from doctors, one can

Offer free lunches or tea at teaching programs.

Share evidence-based literature with them.

Show them data from their department.

Get the Head of Department to issue emails.

66.

In the education program on appropriate patient care practices, an effective strategy will be to

Cover all the recommendations in a similar fashion for all categories of healthcare workers.

Cover only key points to selected groups of healthcare workers who need to know.

Focus on patient care practices that require change especially those that meet resistance from healthcare workers.

Create colourful posters featuring main elements of appropriate patient care practices.

67.

You wanted to reduce healthcare associated MRSA infections in your facility. Your next action is to

Put up posters promoting hand hygiene.

Teach the MRSA Bundle to all staffs.

Form a quality improvement project team.

Install 4% chlorhexidine bottles in all toilets.

68.

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:

communicate with the lab to ensure that they have sufficient resources for the screening exercise

ensure that the correct collection method and device (swab, containers etc) are used

check that request form is completed and samples are labelled

all of the above

69.

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?

Ask the microbiologist for a detailed list of affected patients and get them isolated immediately

Inform you supervisor immediately and then proceed with outbreak control management

Counter propose that it would be better to do a whole genome sequencing instead to confirm clonality

Verify first that these patients had similar phenotypic and antimicrobial susceptibility results

70.

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

Create a case definition for the investigation

Gather additional cases who might be infected

Confirm the existence of an outbreak

Analyse the cases by person, place and time.

71.

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?

Droplet precautions

Contact precautions

Airborne & contact precautions

Droplet & contact precautions

72.

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?

Get a quality improvement team appointed by your supervisor

Do a literature search to support the change proposed by the Director

Validate VAP rates to confirm that there is a problem worth solving

Consult your supervisor on appropriate next steps to be taken

73.

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?

Order a CT scan of the abdomen immediately.

Order a PCR test looking for Clostridioides difficile.

Send off another stool sample, this time to look for Ova, Cysts and Parasites.

Prescribe an anti-diarrheal agent.

74.

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?

Retrospective case-control study

Prospective cohort study

Retrospective prevalence study

Cross sectional study

75.

A bacterial culture result reads “Coagulase negative Staphylococcus (Staphylococcus epidermidis) isolated”. How would you interpret this result?

If the specimen was a superficial wound swab, this could represent colonization by endogenous flora.

If the specimen was a blood culture taken from peripheral venepuncture in a leukaemia patient, this could be a true infection.

If isolated from a blood culture taken from a patient with a central venous catheter, this is a line-related bacteraemia.

Antibiotic treatment is mandatory in all cases where such a report is issued.

76.

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?

Simple, flexible method that gives high quality data

Flexible method that is done according to the surveillance technical manual

Highly acceptable method that is also rigid in its process steps

Simple, flexible method that is highly acceptable and yields high quality data

77.

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?

All the healthcare workers should be vaccinated with conjugate meningococcal vaccine.

Healthcare workers who had close contact with the patient, i.e. intubation or suctioning, should be given antimicrobial prophylaxis.

All healthcare workers managing the patient should be given antimicrobial prophylaxis.

Airborne isolation precautions should be instituted for the infected patient in the first 24 hours of effective antimicrobial therapy.

78.

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

The staff confirms the diagnosis of TB first in this resident.

All residents be screened for all residents in the home to check for patient source.

Staffs need not worry if the resident has no symptoms of cough.

The patient be transferred to an appropriate acute care hospital for evaluation.

79.

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?

File this report as it is only 1 case and wait to see if there is another case later in next 2 weeks

Conduct immediate investigation for probable source for Legionella in the ward

Check with Facilities on recent reports of Legionella from their routine checks

File this report as it is known that Legionella is one of the known pathogens for pneumonia

80.

Before preparing teaching plan to a group of health care workers on infection prevention and control it is necessary to do the following:

Find out participants background, assess the gaps and adopt multiple learning styles.

Prepare and pre-test and post- test, use the most common learning style from the group and assess the gaps.

Have clear learning objectives, provide reading material before the course starts and ensure that they have the same learning styles.

Find out the participants background, prepare ice breaker games and adopt lecture style.

81.

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?

Proceed to inform your supervisor and prompted her that an infection review is indicated here to check on contributory factor for the bacteremia

Contact clinical area supervisor to check on protocol for skin disinfection of central line insertion for patients with bad skin condition

File this incident as this is a first case and wait to see if there are any more bacteremia cases with similar contributory causes

Check on expiry date of the CHG bottle to see if it past safe period for use as there is possibility of ineffective skin disinfection due to expired products

82.

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?

Streptococcus pyogenes – Standard Precautions

Streptococcus agalactiae – Contact Precautions

Staphylococcus aureus – Droplet Precautions

Enterococcus faecium – Contact Precautions

83.

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?

Environmental culture

Visual inspection

ATP (Adenosine triphosphate) method

Fluorescent marker

84.

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:

Involvement in planning of construction and renovation projects

Advising and educating staff including contract staff.

Improving and monitoring patient care practices.

All of the above.

85.

The p value

Provides more information than “95% of confidence interval”.

Varies with sample size.

Should be followed strictly when determining whether an association is present.

Should always be included in any presentation of data results.

86.

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?

Ascertain the scope of the services being performed, in particular the locations that perform sterilization and high-level disinfection.

Perform an initial infection prevention risk assessment to identify high-risk areas and activities such as injections, and reprocessing of reusable devices.

Draft policies and procedures to create a framework which enforces best practice recommendations and benchmarks.

Assemble a multidisciplinary committee which includes leadership to secure buy-in, resources, and ongoing oversight.

87.

In the surveillance of an infection prevention indicator, when would data validation be required?

When a new measure is being introduced.

When the data source has changed.

When there a change in the abstractor.

All of the above

88.

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

The PSAE isolates are very likely to be clonal.

The PSAE isolates are very unlikely to be clonal.

There is inadequate information to differentiate the 2 PSAE isolates.

This is a very uncommon antibiotype for PSAE isolates.

89.

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?

Request for a list of exposed staff and send these for assessment by Occupational Health

Advise them to file this is as an incident requiring further investigation

Assure laboratory staff that the risk is zero to low and hence, no further action needed

Recommend that they contact your supervisor for advice as you are unfamiliar with this

90.

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:

Hepatitis B booster is not necessary

He should receive a booster of Hepatitis B vaccine every 5 years

He should be given 1 dose HBIG and a Hepatitis B booster at A&E Dept

Hepatits B re-vaccination (3 doses) should be initiated at the Needlestick Clinic

91.

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?

Inform all stakeholders regarding incident and get them to retrieve similar packages, which then should be returned to CSSD

Check sterile store and retrieve similar items that should then be removed and sent for re-processing

Contact Patient Safety to get them to convene a root cause analysis immediately

Find out who was responsible for sterilization and find out what happened to get an idea how this could have happened.

92.

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

Clean Surgery

Clean-contaminated Surgery

Contaminated Wound

None of the above

93.

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?

An infection occurring in a patient at the point of admission

An infection occurring in a patient who is not ill at admission or not incubating at the time of admission and subsequently came down with infection

An infection occurring in a patient which the patient already has the signs and symptoms at home

An infection occurring in a patient which the patient has been follow-up with a general practitioner

94.

You are giving recommendations to the Facility Manager on dust containment measures for an upcoming renovation project. Which of the following should be included?

All workers should be certified free of communicable diseases before they are allowed to enter hospital premise.

Infection Prevention & Control Team must be involved in the selection of furnishing materials.

All workers should attend orientation on workplace safety measures before the project starts.

Infection Prevention & Control Team must be consulted and agree with the proposed hoarding measures before the project starts.

95.

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 38.5^oC), 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?

Fever is likely due to septic arthritis, de-escalate antimicrobial to IV Cefazolin

Fever is likely due to HAI, continue IV Piperacillin-tazobactam

Fever is likely due to viral infection, stop all antimicrobials

Fever is likely due to gout flare, stop all antimicrobials

96.

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?

Give her varicella vaccine immediately.

Give her varicella zoster immune globulin immediately.

Give her varicella vaccine if after testing, she is negative for VZV IgG.

Give her varicella zoster immune globulin if after testing, she is negative for VZV IgG.

97.

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?

Arrange for the three patients to be isolated in negative pressurized ICU rooms.

Contact Facilities Team to check if HEPA filter of the air supply to the ward is functioning.

Conduct case control study to verify the existence of an outbreak.

Close down the ward and arrange for the remaining patients to be transferred to another ward.

98.

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:

Intravenous cefazolin should be started first thing in the morning.

Intravenous vancomycin is the drug of choice for him.

Antibiotics should be continued as long as the drain stays in situ.

Intravenous cefazolin should be re-dosed if surgery is longer than 4 hours.

99.

Success in the implementation of guidelines is determined mainly by

Simplicity and clarity of guidelines.

The title and designation of approver of guidelines.

Degree of resistance from healthcare workers.

Support given by Chief Financial Officer.

100.

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?

1 out of 20

Time is Up!

Time's up

ONLINE EXAMINATION PAPER

Previous PostICAS

Next PostAPSIC Sample

Leave a Reply Cancel Reply