VA-BC Infection Prevention & Complication Management 2 — Questions and Answers
Question 1: A patient with a PICC line develops erythema, warmth, and induration at the insertion site without fever. What is the MOST appropriate initial action?
- Remove the PICC immediately
- Apply warm compress and monitor for 24 hours
- Obtain blood cultures and assess for systemic infection (Correct answer)
- Increase the frequency of dressing changes
Correct answer: Obtain blood cultures and assess for systemic infection
Local site signs may indicate early CLABSI; blood cultures from the line and a peripheral site are needed to guide management before removal.
Question 2: Which microorganism is MOST commonly responsible for catheter-related bloodstream infections (CRBSIs) in patients with central venous access devices?
- Pseudomonas aeruginosa
- Coagulase-negative Staphylococci (Correct answer)
- Escherichia coli
- Candida albicans
Correct answer: Coagulase-negative Staphylococci
Coagulase-negative Staphylococci, particularly S. epidermidis, are the most frequent cause of CRBSIs due to biofilm formation on catheter surfaces.
Question 3: What is the recommended dwell time for chlorhexidine gluconate (CHG) solution before accessing a needleless connector?
- 5 seconds
- 10 seconds
- 15 seconds (Correct answer)
- 30 seconds
Correct answer: 15 seconds
INS standards recommend scrubbing needleless connectors with CHG/alcohol for 5–15 seconds and allowing to dry for at least 15 seconds to ensure adequate disinfection.
Question 4: A patient's central line dressing becomes visibly soiled 2 days after placement. When should the dressing be changed?
- At the next scheduled change (day 7)
- Within the next 4 hours
- Immediately (Correct answer)
- After notifying the physician
Correct answer: Immediately
Soiled, wet, or loosened dressings must be changed immediately to prevent bacterial migration along the catheter tract.
Question 5: Which of the following is a risk factor SPECIFIC to tunneled catheters for developing exit-site infections?
- Use of polyurethane material
- Frequent catheter flushing
- Disruption of the fibrous cuff integrity (Correct answer)
- Administration of lipid-based infusions
Correct answer: Disruption of the fibrous cuff integrity
The fibrous cuff of a tunneled catheter acts as a barrier to microbial migration; cuff disruption eliminates this protection and significantly increases exit-site infection risk.
Question 6: A nurse is preparing to access an implanted port. Which antiseptic and technique is recommended for skin preparation?
- Povidone-iodine swab applied in a back-and-forth motion for 5 seconds
- 70% isopropyl alcohol applied in a circular motion and allowed to air dry
- Chlorhexidine gluconate ≥0.5% in alcohol applied with friction and allowed to dry completely (Correct answer)
- Normal saline wipe followed by 2% CHG rinse
Correct answer: Chlorhexidine gluconate ≥0.5% in alcohol applied with friction and allowed to dry completely
CHG ≥0.5% in alcohol with friction application and complete drying is the preferred skin antiseptic for vascular access site preparation per INS and CDC guidelines.
Question 7: Which intervention has demonstrated the GREATEST reduction in CLABSI rates in ICU settings?
- Antibiotic lock therapy for all central lines
- Chlorhexidine bathing of patients daily
- Implementation of a central line insertion bundle (Correct answer)
- Routine catheter exchange over a guidewire every 72 hours
Correct answer: Implementation of a central line insertion bundle
Evidence consistently shows that central line insertion bundles (hand hygiene, maximal barrier precautions, CHG skin prep, optimal site selection, and daily review) produce the greatest CLABSI reductions.
VA-BC Infection Prevention & Complication Management 2
A patient with a PICC line develops erythema, warmth, and induration at the insertion site without fever.
What is the MOST appropriate initial action?