VABC Infection Prevention 4 — Questions and Answers
Question 1: Which needleless connector design has been associated with the highest risk of intraluminal contamination and CLABSI?
- Split-septum connectors with a negative displacement mechanism
- Positive displacement connectors with complex internal pathways (Correct answer)
- Simple mechanical valve connectors
- Luer-lock caps with no internal valve
Correct answer: Positive displacement connectors with complex internal pathways
Positive displacement connectors with complex internal fluid pathways have been associated with increased CLABSI rates due to areas where blood can accumulate and support bacterial growth.
Question 2: How should needleless connector caps be disinfected before each access?
- Wipe with a sterile gauze pad and access immediately
- Scrub with 70% isopropyl alcohol or CHG/alcohol for 5–15 seconds and allow to dry (Correct answer)
- Spray with disinfectant from 6 inches away without wiping
- Rinse with sterile normal saline before and after each use
Correct answer: Scrub with 70% isopropyl alcohol or CHG/alcohol for 5–15 seconds and allow to dry
Scrubbing the needleless connector with an appropriate antiseptic for at least 5–15 seconds followed by air drying reduces hub contamination and CRBSI risk.
Question 3: A vascular access nurse is inserting a PICC in a patient with a known allergy to chlorhexidine. Which alternative skin antiseptic should be used?
- Hydrogen peroxide 3%
- Povidone-iodine 10% allowed to dry completely (Correct answer)
- Benzalkonium chloride 0.1%
- Sterile water with vigorous mechanical scrubbing
Correct answer: Povidone-iodine 10% allowed to dry completely
Povidone-iodine is the recommended alternative skin antiseptic for patients with chlorhexidine allergy, provided adequate contact time and drying are observed.
Question 4: What does the acronym CLABSI stand for in the context of infection surveillance?
- Central Line-Associated Bloodstream Infection (Correct answer)
- Catheter-Linked Arterial Bacteremia and Sepsis Indicator
- Central Lumen Antimicrobial Biofilm Sterilization Index
- Catheter-Localized Abscess and Bacteremia Severity Index
Correct answer: Central Line-Associated Bloodstream Infection
CLABSI stands for Central Line-Associated Bloodstream Infection, a specific surveillance definition used by the CDC/NHSN to track and report infections attributable to central venous access.
Question 5: Which patient population is at HIGHEST risk for developing a catheter-related fungal bloodstream infection?
- Elderly patients with diabetes receiving oral antibiotics
- Immunocompromised patients on broad-spectrum antibiotics receiving total parenteral nutrition (Correct answer)
- Pediatric patients with short-term peripheral IVs
- Ambulatory patients with implanted ports accessed monthly
Correct answer: Immunocompromised patients on broad-spectrum antibiotics receiving total parenteral nutrition
Immunocompromised patients receiving broad-spectrum antibiotics and TPN are at highest risk for Candida CRBSI due to disrupted normal flora, impaired immunity, and a high-nutrient intraluminal environment.
Question 6: Under CDC guidelines, routine replacement of central venous catheters over a guidewire is indicated in which situation?
- Every 72 hours to prevent biofilm formation
- When catheter malfunction occurs in the absence of infection (Correct answer)
- Whenever the dressing becomes soiled or non-adherent
- Every 7 days as a scheduled maintenance measure
Correct answer: When catheter malfunction occurs in the absence of infection
Guidewire exchange is appropriate when the existing catheter is malfunctioning but there is no evidence of infection; it should not be used as a routine prevention strategy.
Question 7: Which INS-recommended practice best prevents air embolism—and simultaneously supports infection prevention—during central venous catheter cap changes?
- Clamping the catheter and having the patient perform the Valsalva maneuver before disconnection (Correct answer)
- Flushing 20 mL NS through the hub to create positive pressure before removing the cap
- Using a recapping needle to prevent hub exposure
- Irrigating the hub with sterile water before applying the new cap
Correct answer: Clamping the catheter and having the patient perform the Valsalva maneuver before disconnection
Clamping the catheter and having the patient perform Valsalva or exhale before cap changes prevents air entry and limits hub exposure time, reducing both air embolism and contamination risk.
VABC Infection Prevention 4
Which needleless connector design has been associated with the highest risk of intraluminal contamination and CLABSI?