NCWO Infection Prevention and Control 2 — Questions and Answers
Question 1: Which topical antimicrobial agent is MOST appropriate for a heavily contaminated wound with suspected Pseudomonas aeruginosa infection?
- Petroleum jelly gauze
- Silver-containing dressing (Correct answer)
- Hydrocolloid dressing
- Plain gauze moistened with normal saline
Correct answer: Silver-containing dressing
Silver-containing dressings have broad-spectrum antimicrobial activity effective against Pseudomonas aeruginosa and other gram-negative organisms, making them appropriate for contaminated wounds.
Question 2: Which of the following antiseptics is generally considered cytotoxic to fibroblasts and should be avoided in granulating wounds?
- Cadexomer iodine
- Medical-grade honey
- Povidone-iodine solution (10%) (Correct answer)
- Dilute sodium hypochlorite (Dakin's 0.025%)
Correct answer: Povidone-iodine solution (10%)
Full-strength povidone-iodine (10%) is cytotoxic to fibroblasts and keratinocytes, impeding wound healing; it should not be used on granulating wounds.
Question 3: A patient with a diabetic foot ulcer develops fever, leukocytosis, and red streaking proximal to the wound. These findings are most consistent with:
- Wound colonization
- Critical colonization
- Cellulitis with possible spreading infection (Correct answer)
- Contact dermatitis
Correct answer: Cellulitis with possible spreading infection
Systemic signs (fever, leukocytosis) combined with erythema spreading from the wound margin indicate cellulitis with a spreading soft-tissue infection requiring prompt systemic antibiotic therapy.
Question 4: Standard precautions require that personal protective equipment (PPE) be used:
- Only when the patient is known to have a communicable disease
- Only when performing aerosol-generating procedures
- When there is potential contact with blood, body fluids, mucous membranes, or non-intact skin (Correct answer)
- Only in intensive care units
Correct answer: When there is potential contact with blood, body fluids, mucous membranes, or non-intact skin
Standard precautions apply universally whenever contact with blood, body fluids, mucous membranes, or non-intact skin is possible, regardless of a patient's known infection status.
Question 5: Which characteristic of wound exudate is MOST suggestive of a gram-negative bacterial infection?
- Serous, watery exudate with no odor
- Thick, creamy, odorless exudate
- Thin, green-blue exudate with a sweet fruity odor (Correct answer)
- Serosanguineous exudate with fibrin strands
Correct answer: Thin, green-blue exudate with a sweet fruity odor
Pseudomonas aeruginosa, a common gram-negative wound pathogen, characteristically produces thin, blue-green exudate with a distinctive sweet, grape-like or fruity odor.
Question 6: In managing biofilm in a chronic wound, which combination approach is considered MOST effective?
- Systemic antibiotics alone for 14 days
- Regular debridement combined with topical antimicrobials (Correct answer)
- Occlusive dressings changed weekly
- Wound irrigation with hydrogen peroxide
Correct answer: Regular debridement combined with topical antimicrobials
Biofilm cannot be eradicated by antibiotics alone; regular debridement to disrupt the matrix combined with topical antimicrobials is the evidence-based standard for biofilm management.
Question 7: Which of the following represents the correct order of donning PPE before entering a contact precaution room?
- Gloves → Gown → Mask → Eye protection
- Gown → Mask → Eye protection → Gloves (Correct answer)
- Mask → Gown → Gloves → Eye protection
- Eye protection → Gloves → Gown → Mask
Correct answer: Gown → Mask → Eye protection → Gloves
CDC guidelines recommend donning PPE in the order: gown first, then mask/respirator, then eye protection, and finally gloves last so that gloves cover the gown cuffs.
NCWO Infection Prevention and Control 2
Which topical antimicrobial agent is MOST appropriate for a heavily contaminated wound with suspected Pseudomonas aeruginosa infection?