CBIC CIC cheat sheet

Incubation periods: varicella 10-21 days; measles 10-12 days; mumps 16-18 days; rubella 14-21 days; pertussis 7-10 days (range 5-21); influenza 1-4 days; norovirus 12-48 hours.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; infection control breaks any one link.

Stages of infectious disease: incubation, prodromal (nonspecific symptoms), illness (peak severity), decline, convalescence.

Colonization = organism present and multiplying without tissue invasion or immune response; infection = invasion with clinical signs and symptoms; contamination = organism on an inanimate surface or in a specimen.

Culture remains the reference standard and permits susceptibility testing; nucleic acid amplification tests (PCR) are more sensitive but detect nucleic acid, not organism viability.

Serology: IgM suggests recent or acute infection; a fourfold rise in pathogen-specific IgG between acute and convalescent sera confirms recent infection; a single positive IgG indicates past exposure or immunity.

Gram-positive cocci in clusters with positive catalase = Staphylococcus (S. aureus is coagulase positive); cocci in chains with negative catalase = Streptococcus.

Prions contain no nucleic acid and are not inactivated by routine disinfection or standard steam cycles; CJD-contaminated instruments require special protocols such as sodium hydroxide, extended steam exposure, or disposal.

Notifiable disease reporting is mandated by state law and submitted to the local health department; the specific list varies by jurisdiction.

Incidence = new cases divided by population at risk during a period; prevalence = all existing cases divided by total population at a point or period (prevalence approximates incidence times duration).

Attack rate = (cases among exposed divided by persons exposed) x 100; comparing exposed and unexposed attack rates identifies the likely source.

Relative risk (cohort) = [a/(a+b)] divided by [c/(c+d)]; odds ratio (case-control) = (a x d) divided by (b x c).

Case definition components: person, place, time, clinical criteria, laboratory criteria; classification is confirmed, probable, or suspected.

Surveillance types: passive (routine reporting by caregivers), active (infection prevention staff seek cases), sentinel (specific site or provider), syndromic (based on signs and symptoms rather than diagnosis).

Outbreak investigation steps: confirm the outbreak exists, verify diagnoses, establish a case definition, case finding, describe by person/place/time, generate and test hypotheses, implement control measures, communicate, follow up.

Device-associated rates = (number of infections divided by number of device-days) x 1000; surgical site infection rates use number of procedures as the denominator.

Standardized infection ratio (SIR) = observed healthcare-associated infections divided by the NHSN risk-adjusted predicted number; SIR below 1.0 indicates fewer infections than predicted and a 95% CI crossing 1.0 indicates no significant difference.

Herd immunity thresholds vary by pathogen: measles approximately 92-95%, diphtheria approximately 85%, poliovirus approximately 80-86%.

Standard precautions apply to every patient regardless of diagnosis: hand hygiene, risk-based PPE, safe injection practices, sharps handling, respiratory hygiene/cough etiquette, environmental cleaning, and linen and waste handling.

Contact precautions (MRSA, VRE, C. difficile, carbapenem-resistant Enterobacteriaceae, scabies, norovirus, RSV): gown and gloves at room entry, single room preferred, dedicated equipment; soap and water for C. difficile and norovirus.

Droplet precautions (influenza, pertussis, mumps, rubella, meningococcus, diphtheria): surgical mask on entry, spatial separation of at least 3 feet (6 feet per some guidance), door may remain open.

Airborne precautions (tuberculosis, measles, varicella, smallpox): fit-tested N95 or higher respirator, airborne infection isolation room with 6-12 air changes per hour and monitored negative pressure, door closed.

WHO 5 moments for hand hygiene: before patient contact, before an aseptic task, after body fluid exposure risk, after patient contact, after touching patient surroundings.

Alcohol-based hand rub is preferred for routine hand decontamination; soap and water is required when hands are visibly soiled and after care of patients with C. difficile or norovirus because alcohol does not reliably kill spores.

Donning order: gown, mask or respirator, eye protection, gloves. Doffing order: gloves, eye protection, gown, then mask or respirator last; hand hygiene follows.

Isolation duration examples: C. difficile until diarrhea resolves (per policy); MRSA and VRE until criteria for discontinuation are met; norovirus until 48 hours after symptom resolution.

Sharps safety: do not recap, bend, or break needles; dispose immediately in puncture-resistant containers at point of use; report exposures immediately for evaluation.

Bloodborne pathogens program requirements: written exposure control plan reviewed annually, hepatitis B vaccine offered free within 10 working days of assignment, PPE provided at no cost, post-exposure evaluation and follow-up.

Percutaneous transmission risk per needlestick: hepatitis B up to approximately 30% (unvaccinated, HBeAg-positive source), hepatitis C approximately 1.8%, HIV approximately 0.3%.

HIV post-exposure prophylaxis: begin as soon as possible, ideally within 2 hours and no later than 72 hours; 28-day antiretroviral regimen; test source and exposed worker for HIV, HBV, HCV.

Hepatitis B post-exposure prophylaxis: unvaccinated worker receives hepatitis B immune globulin plus initiation of the vaccine series; previously vaccinated workers are managed per anti-HBs status.

Hepatitis C: no vaccine and no routinely recommended prophylaxis; monitor HCV RNA and refer for antiviral therapy if seroconversion occurs.

Tuberculosis screening: baseline two-step tuberculin skin test or IGRA, then periodic screening based on risk assessment; IGRA is preferred for BCG-vaccinated healthcare personnel.

Respirator program: fit testing at least annually and whenever the model changes; user seal check before every use; facial hair at the sealing surface prevents an adequate seal.

Work restrictions: exclude personnel with active tuberculosis, measles, varicella, mumps, rubella, or pertussis; food handlers with Salmonella, Shigella, or hepatitis A are managed per public health guidance.

The annual infection prevention risk assessment drives the program plan: population served, services and procedures, community and geographic risk, prior infection rates, and regulatory requirements.

The infection prevention committee is multidisciplinary, meets on a defined schedule, holds written authority, and reports infection data and trends to medical staff and the governing body.

NHSN is the national healthcare-associated infection surveillance system; CMS participation requires reporting of CLABSI, CAUTI, selected SSIs, MRSA bacteremia, and C. difficile laboratory-identified events.

Quality tools: PDSA for rapid-cycle improvement, FMEA for prospective failure analysis, root cause analysis for sentinel events, and control charts to separate common-cause from special-cause variation.

Evidence sources for policy: CDC/HICPAC guidelines, SHEA/IDSA compendium, WHO guidance, AORN and AAMI standards; policies are reviewed on a defined cycle and whenever guidelines change.

Outbreaks and notifiable diseases are reported to the local or state health department under statutory requirements; the reportable list is jurisdiction-specific.

Budget justification compares the attributable cost and excess length of stay of healthcare-associated infections with the cost of the proposed intervention; benchmarking uses NHSN SIR and percentile rankings.

Just culture distinguishes human error, at-risk behavior, and reckless behavior, which supports reporting of events and near misses.

Adult learning principles (Knowles): learners need relevance, build on prior experience, are problem-centered and self-directed; education should target tasks actually performed on the unit.

Learning domains: cognitive (knowledge), affective (attitude), psychomotor (skill); competency validation matches the domain, such as return demonstration for psychomotor skills.

Evidence hierarchy from strongest to weakest: systematic review or meta-analysis, randomized controlled trial, cohort study, case-control study, cross-sectional study, case series, expert opinion.

Reliability is the consistency and reproducibility of a measure; validity is whether the instrument measures the intended concept; sensitivity and specificity describe a test's discrimination.

Human-subjects research requires IRB approval and informed consent; research differs from quality improvement by intent to produce generalizable knowledge.

Education documentation records who was taught, content, date, method, and competency outcome; OSHA and accreditor-required topics include bloodborne pathogens, tuberculosis, hand hygiene, and fire safety.

Teach-back improves comprehension and simulation with return demonstration validates skill; short, frequent sessions improve retention compared with a single annual lecture.

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

Steam sterilization parameters: 121 degrees C (250 degrees F) for 15 minutes at 15 psi, or 132 degrees C (270 degrees F) for 4 minutes; monitor with mechanical, chemical, and biological indicators.

Biological indicators: Geobacillus stearothermophilus spores for steam and hydrogen peroxide systems; Bacillus atrophaeus spores for ethylene oxide and dry heat.

High-level disinfectants include glutaraldehyde, ortho-phthalaldehyde, hydrogen peroxide, and peracetic acid; follow label contact time and temperature, and test the minimum effective concentration of reusable glutaraldehyde.

Low-level disinfectants include quaternary ammonium compounds, phenolics, and chlorine; they must be EPA-registered and used with the labeled contact time for the target organism.

Clostridioides difficile requires a sporicidal agent such as bleach or hydrogen peroxide; alcohol and quaternary ammonium alone do not inactivate spores.

Blood and body fluid spills: 1:10 dilution of 5.25% household bleach (approximately 5000 ppm available chlorine) or an EPA-registered tuberculocidal disinfectant with labeled contact time.

Construction and renovation: the ICRA matrix combines construction activity type with patient risk level to set barriers, HEPA filtration, negative pressure, and traffic control; a water management plan per ASHRAE 188 addresses Legionella risk.

Flexible endoscope reprocessing: leak test, manual cleaning, high-level disinfection, rinse with filtered water, alcohol flush and forced-air drying, and vertical storage.