CIC (Irrigation Association Certifications) cheat sheet

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

Standard precautions apply to all patients regardless of diagnosis; transmission-based precautions (contact, droplet, airborne) are added when the route is known or suspected.

Gram stain: gram-positive retain crystal violet (thick peptidoglycan); gram-negative decolorize and counterstain pink; shape (coccus, bacillus) guides empiric therapy.

Culture media: blood agar shows hemolysis patterns; MacConkey selects gram-negative rods and detects lactose fermentation; chocolate agar supports fastidious organisms such as Haemophilus and Neisseria.

Sterile body sites (blood, CSF, pleural fluid) yield pathogens when cultured; specimens from nonsterile sites (sputum, wound) require interpretation against colonizing flora.

Incubation periods that inform exposure windows: influenza 1–4 days; measles 10–14 days; varicella 10–21 days; tuberculosis 2–10 weeks from infection to positive tuberculin test.

Notifiable disease reporting is mandated by state or local health jurisdiction; the list and timeframes vary, and reporting is not optional for listed conditions.

Serology distinguishes IgM (recent or acute infection) from IgG (past infection or immunity); paired acute and convalescent sera showing a fourfold titer rise support acute infection.

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

Attack rate = (number of cases / number exposed) × 100; used in outbreak settings to compare exposed and unexposed groups.

Outbreak steps: confirm the diagnosis, establish a case definition, find cases, describe by person/place/time, generate hypotheses, test hypotheses, implement control, communicate.

Case definition tiers: confirmed (laboratory-verified), probable (clinical criteria plus epidemiologic link), suspected (clinical criteria only).

Epidemic curve shape: point source (single sharp peak within one incubation period), common continuous source (plateau), propagated (successive peaks one incubation period apart).

Healthcare-associated infection surveillance uses standardized definitions (for example NHSN) so rates are comparable; device-day denominators (central line-days, ventilator-days, catheter-days) normalize rates.

Standardized infection ratio (SIR) = observed infections / predicted infections from a national baseline; SIR below 1 means fewer infections than predicted.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); predictive value depends on prevalence.

Hand hygiene indications (WHO five moments): before patient contact, before aseptic task, after body fluid exposure risk, after patient contact, after touching patient surroundings.

Alcohol-based hand rub is preferred for routine decontamination when hands are not visibly soiled; soap and water is required for visible soil and for spore-forming organisms such as Clostridioides difficile.

Contact precautions: gown and gloves on entry; used for MRSA, VRE, C. difficile, and other multidrug-resistant organisms or diarrheal illness.

Droplet precautions: surgical mask plus standard precautions within about 3 feet; used for influenza, pertussis, meningococcal disease, and group A streptococcal pharyngitis.

Airborne precautions: N95 or higher respirator, negative-pressure room with 6–12 air changes per hour, door closed; used for tuberculosis, measles, and varicella.

N95 respirator requires a user seal check each donning; fit testing is done at least annually and after facial changes or new model introduction.

Sequence for donning PPE: hand hygiene, gown, mask or respirator, eye protection, gloves; removal reverses order with glove and hand hygiene emphasized.

Environmental cleaning: shared equipment is cleaned between patients; high-touch surfaces require routine disinfection with an EPA-registered product active against the target organism.

Post-exposure management for bloodborne pathogens: wash the site, report immediately, assess source and exposure, and start HIV postexposure prophylaxis within hours when indicated (best within 2 hours, up to 72 hours).

Hepatitis B: unvaccinated exposed staff receive hepatitis B immune globulin plus vaccine series; documented anti-HBs of 10 mIU/mL or greater indicates immunity.

Tuberculosis screening for healthcare personnel: baseline tuberculin skin test or interferon-gamma release assay, then periodic screening based on risk assessment; positive results require symptom review and chest imaging.

Influenza vaccination is the primary prevention strategy for healthcare personnel; declination programs may require masking during periods of increased influenza activity.

Pertussis exposure: healthcare personnel with close exposure receive postexposure azithromycin prophylaxis and are excluded from work until 5 days of antibiotics completed or 21 days after exposure.

Varicella: staff without evidence of immunity are excluded from work from day 10 through day 21 after exposure (day 28 if immune globulin given).

Measles: unvaccinated or nonimmune exposed staff are excluded from day 5 through day 21 after exposure; two documented MMR doses constitute immunity.

Needlestick risk per exposure: hepatitis B roughly 6–30 percent for HBeAg-positive source, hepatitis C about 1.8 percent, HIV about 0.3 percent.

Outbreak communication: single designated spokesperson, pre-approved message templates, and consistent messaging across shifts to prevent conflicting information.

Regulatory drivers: Joint Commission infection control standards, CMS Conditions of Participation, and OSHA bloodborne pathogens standard each impose distinct documentation and reporting duties.

Infection prevention committee should include medical staff, nursing, laboratory, pharmacy, environmental services, and administration, with defined reporting to the governing body.

Antimicrobial stewardship core elements: leadership commitment, accountability, drug expertise, action (prior authorization or prospective audit and feedback), tracking, reporting, education.

Risk assessment (annual, facility-wide) identifies high-risk populations, procedures, and pathogens and drives the infection prevention plan and resource allocation.

Root cause analysis or apparent cause analysis follows serious events such as a cluster of surgical site infections; findings translate into measurable action plans with owners and dates.

Hand hygiene program measurement combines direct observation, product consumption, and validated surrogates; feedback to units improves compliance more than education alone.

Policy review cycle: policies are reviewed at defined intervals (commonly every 3 years) and whenever guidance, regulation, or facility practice changes.

Learning objectives use measurable verbs (identify, demonstrate, calculate) rather than vague verbs (know, understand) so competency can be assessed.

Competency validation pairs a knowledge test with direct observation or return demonstration; annual competency is required for infection prevention staff and for clinical staff on high-risk practices.

Study designs: randomized controlled trial (strongest for causation), cohort (incidence and relative risk), case-control (rare outcomes, odds ratio), cross-sectional (prevalence only).

Relative risk = incidence in exposed / incidence in unexposed; odds ratio approximates relative risk when the outcome is rare.

Confounding is addressed in design (randomization, restriction, matching) or analysis (stratification, multivariable regression).

Internal validity concerns bias and confounding; external validity concerns generalizability to other populations and settings.

Evidence hierarchy: systematic reviews and meta-analyses above randomized trials, then cohort, case-control, case series, and expert opinion.

Research ethics: institutional review board approval is required before human-subjects data collection, and informed consent must be documented unless waived.