RNC-NIC Infection Control 2 — Questions and Answers
Question 1: A neonate born at 28 weeks gestation has a central venous catheter. Which intervention is MOST effective in preventing catheter-associated bloodstream infections (CLABSI)?
- Change the catheter every 72 hours routinely
- Use chlorhexidine-impregnated dressings and perform daily necessity checks (Correct answer)
- Apply antibiotic ointment to the insertion site daily
- Flush the catheter with heparin every 4 hours
Correct answer: Use chlorhexidine-impregnated dressings and perform daily necessity checks
Daily necessity reviews and chlorhexidine dressings are key CLABSI bundle components proven to reduce infection rates in the NICU.
Question 2: Which organism is the MOST common cause of late-onset sepsis in very low birth weight (VLBW) neonates in the NICU?
- Escherichia coli
- Coagulase-negative Staphylococcus (CoNS) (Correct answer)
- Group B Streptococcus
- Candida albicans
Correct answer: Coagulase-negative Staphylococcus (CoNS)
CoNS, particularly Staphylococcus epidermidis, is the leading cause of late-onset sepsis in VLBW neonates due to skin colonization and invasive devices.
Question 3: A nurse is preparing to insert a peripherally inserted central catheter (PICC) in a neonate. Which PPE combination represents the HIGHEST level of sterile technique required?
- Clean gloves and mask
- Sterile gloves, gown, mask, and cap with maximal barrier precautions (Correct answer)
- Sterile gloves and face shield only
- N95 respirator and sterile gloves
Correct answer: Sterile gloves, gown, mask, and cap with maximal barrier precautions
Maximal sterile barrier precautions including sterile gown, gloves, mask, cap, and large sterile drape are required for central line insertion to prevent CLABSI.
Question 4: When should the NICU nurse use Contact Precautions in addition to Standard Precautions for a neonate?
- For all neonates regardless of infection status
- Only when the neonate has a confirmed bacterial infection
- When caring for neonates with known or suspected multi-drug resistant organisms (MDROs) (Correct answer)
- When the neonate is on mechanical ventilation
Correct answer: When caring for neonates with known or suspected multi-drug resistant organisms (MDROs)
Contact Precautions are added to Standard Precautions when MDROs such as MRSA or VRE are known or suspected to prevent transmission.
Question 5: A neonate with NEC (necrotizing enterocolitis) is showing signs of clinical deterioration. The nurse notices multiple infants in the NICU bay have similar symptoms. What is the PRIORITY action?
- Administer broad-spectrum antibiotics to all symptomatic neonates
- Notify infection control and initiate a cluster investigation immediately (Correct answer)
- Transfer all affected neonates to private rooms
- Increase feeding volumes to maintain nutrition
Correct answer: Notify infection control and initiate a cluster investigation immediately
A cluster of NEC cases may indicate an outbreak requiring immediate infection control notification and epidemiologic investigation to identify a common source.
Question 6: Which hand hygiene agent is the PREFERRED choice for routine hand decontamination in the NICU when hands are not visibly soiled?
- Plain soap and water for at least 15 seconds
- Alcohol-based hand rub (ABHR) applied until dry (Correct answer)
- Antimicrobial soap with chlorhexidine for 30 seconds
- Povidone-iodine scrub solution
Correct answer: Alcohol-based hand rub (ABHR) applied until dry
Alcohol-based hand rubs are the preferred agent for routine hand hygiene in healthcare settings when hands are not visibly soiled due to superior efficacy and efficiency.
Question 7: A preterm neonate on total parenteral nutrition (TPN) develops a fever and blood cultures grow Candida parapsilosis. What is the MOST important intervention beyond antifungal therapy?
- Start prophylactic fluconazole for all NICU infants
- Remove the central venous catheter as soon as possible (Correct answer)
- Perform a lumbar puncture immediately
- Increase the dextrose concentration in TPN
Correct answer: Remove the central venous catheter as soon as possible
Candida biofilm on central catheters serves as a persistent source; catheter removal is essential for source control in neonatal candidemia.
RNC-NIC Infection Control 2
A neonate born at 28 weeks gestation has a central venous catheter.
Which intervention is MOST effective in preventing catheter-associated bloodstream infections (CLABSI)?