VABC Infection Prevention 5 — Questions and Answers
Question 1: Which component of the central line insertion bundle specifically targets the patient's skin flora as the primary contamination source?
- Maximal sterile barrier precautions
- Chlorhexidine gluconate skin antisepsis (Correct answer)
- Optimal catheter site selection
- Daily necessity review
Correct answer: Chlorhexidine gluconate skin antisepsis
Chlorhexidine gluconate skin antisepsis directly targets cutaneous microorganisms at the insertion site, which are the primary source of extraluminal catheter colonization.
Question 2: A patient receiving home infusion therapy through a tunneled catheter presents with fever and chills that occur within 2 hours of starting the infusion. The nurse suspects which catheter complication first?
- Catheter occlusion from fibrin sheath
- Catheter-related bloodstream infection (Correct answer)
- Catheter tip malposition
- Infusion-related phlebitis
Correct answer: Catheter-related bloodstream infection
Fever and rigors temporally associated with catheter infusion are classic signs of CRBSI, as flushing disturbs biofilm and releases organisms into the bloodstream.
Question 3: For implanted venous ports, which dressing type and change frequency is recommended by INS when the site is well-healed and accessed with a non-coring needle?
- Sterile gauze changed every 24 hours while the needle is in place
- Transparent semipermeable membrane changed every 7 days or sooner if integrity is compromised (Correct answer)
- Dry gauze changed every 48 hours with povidone-iodine reapplication
- No dressing required once the site is fully healed and the needle is secured
Correct answer: Transparent semipermeable membrane changed every 7 days or sooner if integrity is compromised
INS recommends a TSM dressing changed every 7 days (or sooner if non-intact) over an accessed implanted port needle to maintain a sterile barrier at the insertion site.
Question 4: When drawing blood cultures to diagnose a suspected CRBSI, the CORRECT technique includes:
- Drawing both sets of cultures exclusively through the central catheter for accuracy
- Drawing one set peripherally and one set through each catheter lumen, labeling all samples with source and time (Correct answer)
- Drawing cultures only after removing the catheter and culturing the tip
- Obtaining a single blood culture set peripherally and starting antibiotics immediately
Correct answer: Drawing one set peripherally and one set through each catheter lumen, labeling all samples with source and time
Paired blood cultures drawn simultaneously from a peripheral vein and through the catheter, each labeled with source and time, allow differential time-to-positivity analysis to confirm catheter origin.
Question 5: Which statement BEST describes the role of ethanol lock therapy in vascular access infection prevention?
- Ethanol lock is used to dissolve fibrin occlusions and does not have antimicrobial properties
- Ethanol lock instills 70% ethanol into the catheter lumen to sterilize biofilm and is used prophylactically or therapeutically in high-risk patients (Correct answer)
- Ethanol lock is approved only for arterial catheters and not central venous catheters
- Ethanol lock therapy requires catheter removal for the solution to be effective
Correct answer: Ethanol lock instills 70% ethanol into the catheter lumen to sterilize biofilm and is used prophylactically or therapeutically in high-risk patients
Ethanol lock therapy uses 70% ethanol dwelling in the catheter lumen to eradicate biofilm-embedded organisms and is used prophylactically in high-risk patients (e.g., pediatric oncology, home PN) or therapeutically for catheter salvage.
Question 6: A vascular access team is implementing a quality improvement project to reduce CLABSI rates. Which metric is the STANDARD way to express and benchmark CLABSI incidence?
- Number of CLABSIs per 100 catheter insertions
- Number of CLABSIs per 1,000 central line days (Correct answer)
- Percentage of patients who develop CLABSI during hospitalization
- Number of CLABSIs per 100 patient admissions
Correct answer: Number of CLABSIs per 1,000 central line days
CLABSI rates are expressed per 1,000 central line days to account for the duration of catheter exposure, allowing meaningful comparison across units and institutions.
Question 7: Which precaution is MOST important when replacing IV administration sets connected to a central venous catheter used for lipid-containing parenteral nutrition?
- Replacing the tubing every 96 hours using clean technique
- Replacing the tubing within 24 hours of initiating lipid-containing PN using aseptic technique (Correct answer)
- Replacing the tubing only when visibly soiled or when the PN bag is changed
- Replacing the tubing every 72 hours regardless of PN composition
Correct answer: Replacing the tubing within 24 hours of initiating lipid-containing PN using aseptic technique
CDC and INS guidelines recommend replacing IV tubing used for lipid-containing PN or blood products within 24 hours because lipids support microbial growth more rapidly than dextrose/amino acid solutions.
VABC Infection Prevention 5
Which component of the central line insertion bundle specifically targets the patient's skin flora as the primary contamination source?