NPS Infection Prevention and Control 2 — Questions and Answers
Question 1: During an outbreak of necrotizing enterocolitis (NEC) in a NICU, which pathogen is most commonly implicated in epidemic NEC clusters?
- Staphylococcus aureus
- Cronobacter sakazakii (Correct answer)
- Rotavirus
- Group B Streptococcus
Correct answer: Cronobacter sakazakii
Cronobacter sakazakii (formerly Enterobacter sakazakii) is strongly associated with epidemic NEC outbreaks in premature neonates, often traced to contaminated powdered infant formula.
Question 2: Which element of the central line insertion bundle is considered most critical for CLABSI prevention?
- Selecting the femoral vein as the preferred insertion site
- Maximal sterile barrier precautions during catheter insertion (Correct answer)
- Routine catheter replacement every 72 hours
- Prophylactic antibiotic administration at time of insertion
Correct answer: Maximal sterile barrier precautions during catheter insertion
Maximal sterile barrier precautions — cap, mask, sterile gown, sterile gloves, and full-body sterile drape — at the time of insertion are the most effective bundle component for preventing CLABSI.
Question 3: What is the recommended empirical antibiotic regimen for early-onset neonatal sepsis in a term neonate?
- Vancomycin and cefotaxime
- Ampicillin and gentamicin (Correct answer)
- Meropenem and vancomycin
- Clindamycin and azithromycin
Correct answer: Ampicillin and gentamicin
Ampicillin and gentamicin is the standard first-line empirical regimen for early-onset sepsis, providing coverage for the predominant pathogens: Group B Streptococcus, Listeria monocytogenes, and gram-negative enteric organisms.
Question 4: A transport team prepares to move a neonate with confirmed pertussis. What isolation precautions are required during transport?
- Standard precautions only
- Contact precautions only
- Droplet precautions (Correct answer)
- Airborne precautions with N95 respirator
Correct answer: Droplet precautions
Pertussis (Bordetella pertussis) is transmitted by large respiratory droplets; droplet precautions with surgical mask and eye protection are required for healthcare workers within 3 feet of the patient.
Question 5: What is the minimum recommended duration of antibiotic therapy for confirmed gram-negative neonatal bacterial meningitis?
- 7 days
- 10–14 days
- 14–21 days
- 21 days minimum (Correct answer)
Correct answer: 21 days minimum
Gram-negative neonatal bacterial meningitis requires a minimum of 21 days of antibiotic therapy due to the severity of infection, high mortality risk, and potential for relapse.
Question 6: Which healthcare worker behavior is the most modifiable and impactful risk factor for MRSA transmission in the NICU?
- Inadequate hand hygiene between patient contacts (Correct answer)
- Use of shared stethoscopes without disinfection
- Speaking without a mask near the isolette
- Using the same blood pressure cuff on multiple patients
Correct answer: Inadequate hand hygiene between patient contacts
Inadequate hand hygiene between patient contacts is the most significant and most preventable risk factor for MRSA and other pathogen transmission in any healthcare environment.
Question 7: Which antiseptic agent used for central venous catheter skin preparation in preterm neonates carries a risk of systemic iodine absorption leading to hypothyroidism?
- 70% isopropyl alcohol
- Povidone-iodine (Correct answer)
- Chlorhexidine gluconate
- Benzalkonium chloride
Correct answer: Povidone-iodine
Povidone-iodine can be absorbed through the thin skin of preterm neonates, leading to systemic iodine accumulation and transient hypothyroidism; it should be thoroughly rinsed off after use.
NPS Infection Prevention and Control 2
During an outbreak of necrotizing enterocolitis (NEC) in a NICU, which pathogen is most commonly implicated in epidemic NEC clusters?