VABC Infection Prevention 2 — Questions and Answers
Question 1: Which organism is most commonly responsible for catheter-related bloodstream infections (CRBSI) in vascular access patients?
- Escherichia coli
- Staphylococcus epidermidis (Correct answer)
- Pseudomonas aeruginosa
- Enterococcus faecalis
Correct answer: Staphylococcus epidermidis
Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, are the most frequent cause of CRBSI due to their ability to form biofilms on catheter surfaces.
Question 2: What is the recommended maximum number of days a peripheral IV catheter should remain in place in adults before elective rotation to a new site?
- 24 hours
- 48 hours
- 72–96 hours (Correct answer)
- 7 days
Correct answer: 72–96 hours
CDC guidelines recommend replacing peripheral IV catheters every 72–96 hours in adults to reduce the risk of phlebitis and infection.
Question 3: A patient's PICC insertion site shows erythema, warmth, and purulent drainage 10 days post-insertion. The FIRST priority action by the vascular access nurse is to:
- Apply a topical antibiotic ointment and re-dress the site
- Notify the provider and prepare for catheter removal (Correct answer)
- Flush the catheter with heparinized saline to clear any clot
- Obtain a blood culture from a peripheral vein only
Correct answer: Notify the provider and prepare for catheter removal
Signs of local infection with purulent drainage indicate a likely infected catheter, requiring prompt provider notification and evaluation for removal.
Question 4: Chlorhexidine-impregnated sponge dressings are indicated primarily to reduce which complication of central venous catheters?
- Catheter occlusion from fibrin sheath
- Catheter-related bloodstream infection (Correct answer)
- Air embolism during dressing change
- Catheter tip migration
Correct answer: Catheter-related bloodstream infection
Chlorhexidine-impregnated sponge dressings reduce microbial colonization at the insertion site, thereby lowering the risk of CRBSI.
Question 5: When performing a central line dressing change, which action is most important for infection prevention?
- Using sterile gloves and a sterile field throughout the procedure (Correct answer)
- Applying povidone-iodine ointment to the insertion site routinely
- Changing the dressing every 24 hours regardless of condition
- Flushing the catheter with normal saline before removing the old dressing
Correct answer: Using sterile gloves and a sterile field throughout the procedure
Maintaining sterile technique with sterile gloves and a sterile field during dressing changes is fundamental to preventing catheter site contamination.
Question 6: Which of the following best describes the concept of 'biofilm' as it relates to vascular access infection risk?
- A layer of fibrin clot that occludes the catheter lumen
- A protective coating of glycocalyx-embedded microorganisms on the catheter surface (Correct answer)
- An inflammatory reaction around the catheter tip in the vasculature
- A chemical film left by incompatible IV flush solutions
Correct answer: A protective coating of glycocalyx-embedded microorganisms on the catheter surface
Biofilm is a structured community of microorganisms encased in a self-produced matrix that adheres to catheter surfaces and is highly resistant to antibiotics and host defenses.
Question 7: According to SHEA/IDSA guidelines, which practice is recommended to reduce CLABSI rates in ICU settings?
- Routine guidewire exchange of central lines every 72 hours
- Use of a standardized catheter insertion checklist and bundle approach (Correct answer)
- Applying bacitracin ointment to all central catheter exit sites daily
- Restricting central line access to attending physicians only
Correct answer: Use of a standardized catheter insertion checklist and bundle approach
Bundle approaches with standardized checklists (hand hygiene, maximal barrier precautions, CHG skin prep, optimal site selection, daily necessity review) have demonstrated significant CLABSI reductions.
VABC Infection Prevention 2
Which organism is most commonly responsible for catheter-related bloodstream infections (CRBSI) in vascular access patients?