VABC Infection Prevention 3 — Questions and Answers
Question 1: A nurse prepares to access an implanted port. Which skin antiseptic and contact time is recommended by INS standards before needle insertion?
- 70% isopropyl alcohol for 15 seconds
- >0.5% chlorhexidine in alcohol with 30-second scrub and full dry time (Correct answer)
- 10% povidone-iodine for 60 seconds without wiping
- Benzalkonium chloride wipe for 10 seconds
Correct answer: >0.5% chlorhexidine in alcohol with 30-second scrub and full dry time
INS standards recommend chlorhexidine gluconate (>0.5%) in alcohol applied with friction for at least 30 seconds, followed by complete drying before accessing an implanted port.
Question 2: Which factor most significantly increases a patient's risk of developing a CLABSI?
- Use of a triple-lumen catheter versus a single-lumen catheter (Correct answer)
- Catheter insertion in the radiology suite rather than the ICU
- Using ultrasound guidance for insertion
- Selecting the subclavian vein as the insertion site
Correct answer: Use of a triple-lumen catheter versus a single-lumen catheter
Multi-lumen catheters have more access points, increasing opportunities for hub contamination and microbial entry, which raises CLABSI risk compared to single-lumen catheters.
Question 3: During a central line dressing change, a nurse notes the transparent semipermeable membrane (TSM) dressing is lifting at the edges but the site appears clean. The correct action is to:
- Reinforce the edges with tape and leave the dressing in place for the full 7-day interval
- Change the dressing immediately, as a non-intact dressing increases infection risk (Correct answer)
- Cover with a gauze dressing and schedule a full change in 48 hours
- Apply sterile strips over the lifted edges and reassess in 24 hours
Correct answer: Change the dressing immediately, as a non-intact dressing increases infection risk
A dressing that is no longer intact, wet, or lifting compromises the sterile barrier and must be changed promptly regardless of scheduled interval.
Question 4: Which of the following is the most appropriate catheter site for reducing CLABSI risk in non-tunneled central venous catheters in adult patients?
- Femoral vein
- Internal jugular vein
- Subclavian vein (Correct answer)
- Antecubital vein via cut-down
Correct answer: Subclavian vein
The subclavian site is associated with the lowest CLABSI and thrombosis rates among non-tunneled CVC insertion sites in adults per CDC guidelines.
Question 5: What is the purpose of performing daily 'line necessity' reviews for central venous catheters?
- To document catheter patency and flow rates for billing purposes
- To ensure catheters are removed promptly when no longer clinically needed, reducing infection risk (Correct answer)
- To schedule routine guidewire exchanges every 5 days
- To assess for thrombosis with bedside Doppler ultrasound
Correct answer: To ensure catheters are removed promptly when no longer clinically needed, reducing infection risk
Daily necessity reviews are a core CLABSI bundle element; prompt removal of unnecessary catheters is one of the most effective ways to reduce infection risk.
Question 6: A patient with a tunneled hemodialysis catheter is prescribed an antibiotic lock solution. What is the PRIMARY goal of this therapy?
- To flush fibrin sheaths from the catheter tip
- To sterilize the catheter lumen and eradicate intraluminal biofilm without catheter removal (Correct answer)
- To anticoagulate the catheter between dialysis sessions
- To prevent thrombosis by maintaining catheter patency
Correct answer: To sterilize the catheter lumen and eradicate intraluminal biofilm without catheter removal
Antibiotic lock therapy delivers high-concentration antibiotics directly into the catheter lumen to eradicate biofilm-associated organisms, potentially allowing catheter salvage.
Question 7: When using maximal sterile barrier precautions for CVC insertion, which personal protective equipment is required for the inserting clinician?
- Clean gloves and surgical mask only
- Sterile gloves, sterile gown, cap, mask, and large sterile drape covering the patient (Correct answer)
- Sterile gloves and face shield without gown
- N95 respirator, sterile gloves, and sterile gown without patient draping
Correct answer: Sterile gloves, sterile gown, cap, mask, and large sterile drape covering the patient
Maximal sterile barrier precautions include sterile gloves, sterile gown, cap, surgical mask, and a large sterile drape covering the entire patient to minimize contamination risk.
VABC Infection Prevention 3
A nurse prepares to access an implanted port.
Which skin antiseptic and contact time is recommended by INS standards before needle insertion?