CIC (AAPC) cheat sheet

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; breaking any link interrupts transmission.

Gram stain: gram-positive retain crystal violet (purple); gram-negative decolorize and counterstain pink; shape (cocci, bacilli) narrows organism identity.

Culture incubation: most bacterial pathogens recovered at 35-37 C in 18-24 h; some fastidious organisms need special media or prolonged incubation.

Sterile body sites (blood, CSF, pleural fluid) are normally sterile; growth there is significant, whereas sputum and wound cultures need interpretation for colonization.

Sensitivity vs specificity: sensitivity detects true positives; specificity detects true negatives; predictive values shift with disease prevalence.

Notifiable diseases are reported to public health authorities per jurisdiction-specific lists; reporting is mandated, not discretionary.

Healthcare-associated infection timing: an infection is often classified HAI if it manifests at or after 48 hours of admission and was not incubating on admission.

Antimicrobial resistance mechanisms include enzymatic inactivation (beta-lactamase), altered target, decreased permeability, and efflux pumps.

Incidence = new cases / population at risk per time period; prevalence = all existing cases / total population at a point or period.

Attack rate = (number ill / number exposed) x 100; useful in outbreaks to compare exposed versus unexposed groups.

Outbreak steps: confirm existence, verify diagnosis, define case, find cases, describe by person/place/time, form hypothesis, test, intervene, communicate.

Epidemic curve shape: point source peaks once; continuous common source plateaus; propagated (person-to-person) shows successive peaks one incubation period apart.

Standardized infection ratio (SIR) = observed infections / predicted infections; SIR > 1 means more infections than expected after risk adjustment.

Device-associated rates use device-days as denominator (e.g., central line-associated bloodstream infections per 1,000 line-days).

Case definition components: clinical criteria, time, place, and person, with confirmed, probable, and suspect classifications.

Relative risk compares incidence in exposed vs unexposed; odds ratios approximate risk when disease is rare.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask/eye protection based on anticipated exposure, safe injection practices.

Transmission-based precautions: contact (direct/indirect), droplet (large respiratory droplets, travel ~3-6 feet), airborne (small particles, remain suspended, need airborne infection isolation room).

Airborne precautions require a negative-pressure room with air exchanges per hour and fit-tested N95 or higher respirator for entry.

Hand hygiene is the single most effective prevention measure; alcohol-based rub for routine, soap and water when visibly soiled or for spore-formers like C. difficile.

Contact precautions typically require gloves and gown; dedicated equipment where possible; hand hygiene before and after glove use.

Droplet precautions apply to influenza, pertussis, and meningococcal disease; mask the patient during transport.

PPE sequence: don gown, mask/respirator, eye protection, gloves; remove gloves first, then eye protection, gown, mask; perform hand hygiene after removal.

Isolation duration varies by organism and is often tied to culture negativity or a defined period after symptom resolution.

Post-exposure prophylaxis for hepatitis B depends on worker immunity status; unvaccinated exposed workers may receive HBIG plus vaccine series.

Needlestick protocol: wash site with soap and water, report immediately, assess source and worker serology, and initiate PEP per protocol within hours.

Tuberculosis screening of healthcare workers uses symptom assessment plus interferon-gamma release assay or tuberculin skin test; positive TST is typically >= 5 mm in high-risk HCW settings.

Influenza vaccination of healthcare workers reduces transmission to patients; declination policies vary by jurisdiction.

Bloodborne pathogen exposure risk varies by pathogen: hepatitis B is most transmissible per needlestick, then hepatitis C, then HIV (lowest).

Fit testing for N95 respirators is required annually and whenever facial changes affect seal; user seal checks are performed each donning.

Occupational health tracks immunity for measles, mumps, rubella, varicella, and hepatitis B; documented immunity or vaccination is required for many roles.

Outbreak communication: report internally to leadership and infection prevention, and externally to public health per regulation and time frame.

Root cause analysis and failure mode analysis are used to investigate serious infection events and system failures.

Performance improvement cycle: plan-do-study-act (PDSA) iterates small tests of change with measurement after each cycle.

Key performance indicators for infection prevention include hand hygiene compliance, device utilization ratios, and SIR trends.

Multidisciplinary teams (nursing, physicians, pharmacy, laboratory, environmental services) drive antimicrobial stewardship and infection reduction.

Policy and procedure documents require scheduled review and version control; changes are communicated and staff competency documented.

Regulatory and accrediting bodies set standards for infection control programs; survey readiness requires ongoing documentation, not last-minute preparation.

Learning objectives should be measurable and tied to observable behaviors (e.g., demonstrate correct PPE doffing), not vague goals.

Competency assessment combines knowledge testing with direct observation of practice; return demonstration verifies skill.

Adult learning principles: relevance to practice, problem-centered content, and immediate application improve retention.

Research designs: randomized controlled trials best establish causality; cohort and case-control studies are observational; case reports describe single events.

Levels of evidence rank systematic reviews and RCTs above observational studies and expert opinion.

Validity in research: internal validity concerns causal inference; external validity concerns generalizability to other settings.

Continuing education credits and certification maintenance require documented activities; outcomes of education should be evaluated with pre/post measures.

Airborne infection isolation rooms maintain negative pressure relative to corridors; pressure differential is monitored and documented.

Operating room ventilation typically provides positive pressure with high air exchange rates and HEPA-filtered supply air.

Water systems harbor Legionella and Pseudomonas; risk management includes temperature control, flushing low-use fixtures, and monitoring.

Construction and renovation require an infection control risk assessment (ICRA) with barriers, dust control, and traffic routing.

Environmental surfaces are classified as high-touch (frequently cleaned) versus low-touch; cleaning frequency is based on touch and contamination risk.

Medical waste segregation: sharps into puncture-resistant containers; regulated medical waste separated from general waste per regulation.

Ice machines, sinks, and decorative fountains are potential reservoirs and require cleaning and maintenance schedules.

Spaulding classification: critical items (enter sterile tissue) require sterilization; semicritical (contact mucous membranes) require high-level disinfection; noncritical (intact skin) require low-level disinfection.

Sterilization methods include steam autoclave (moist heat), ethylene oxide (heat-sensitive items), hydrogen peroxide gas plasma, and dry heat.

High-level disinfectants include glutaraldehyde and ortho-phthalaldehyde; they inactivate all microorganisms except high numbers of bacterial spores.

Cleaning must precede disinfection or sterilization; organic material and biofilm reduce biocide efficacy.

Biological indicators with spores (e.g., Geobacillus stearothermophilus for steam) verify sterilization efficacy; chemical indicators monitor process parameters only.

Contact time (dwell time) is the manufacturer-specified exposure needed for a disinfectant to be effective; it is not optional.

Alcohol is not a sterilant and is not sporicidal; it is a low-to-intermediate disinfectant for some surfaces and skin antisepsis.