Chapter 03: The Laboratory Role in Infection Control

Mahon: Textbook of Diagnostic Microbiology, 6th Edition

MULTIPLE CHOICE

1. In acute care hospitals, transmission of pathogens as a result of treatment occurs as all the
following “classifications” of infections, except
a. hand hygiene-acquired infections.
b. surgical site infections.
c. catheter-related bloodstream infections.
d. ventilator-associated pneumonias.
ANS: A
Although infections can be transmitted through improper hand hygiene, it is not a
classification of infection acquired in a hospital. Good handwashing technique is essential for
preventing the spread of pathogens in a health care setting, but infections are not classified as
hand hygiene-acquired infections. Surgical site infections, catheter-related bloodstream
infections, and ventilator-associated pneumonias are acquired from a treatment rendered to the
patient. For example, catheter-related bloodstream infections usually occur when patients have
sterile catheter devices implanted into their bloodstream. Because of the invasive nature of the
catheter, bacteria can colonize on the catheter and cause sepsis. The patient did not enter the
hospital with this infection, but acquired the infection as a result of medical treatment.

OBJ: Level 1: Recall

2. An iatrogenic infection is one that

a. is caused by gram-negative bacteria.
b. occurs as a result of medical treatment.
c. is found in urinary tract infections.
d. is not subject to outbreak investigation.
ANS: B
The definition of an iatrogenic infection is one that is acquired in a health care setting.
Iatrogenic infections can be caused by gram-negative bacteria, but other types of bacteria may
also cause these types of infections (i.e., methicillin-resistant Staphylococcus aureus, MRSA).
Urinary tract infections can be a type of iatrogenic infection, but other types of infections are
also iatrogenic. Because an iatrogenic infection is acquired in a health care setting, outbreak
investigations are routinely conducted to determine the source of the infection so that the
bacteria can be killed and the spread of infection stopped.

OBJ: Level 1: Recall

3. This ongoing process helps public health and health care officials recognize outbreaks,
upward trends of infections, and positive effects of interventions.
a. Handwashing techniques
b. Intervention
c. Surveillance
d. Antimicrobial resistance
ANS: C
 Handwashing techniques help to prevent the spread of pathogens, and antimicrobial resistance
identifies organisms that are resistant to particular antibiotics, but these do not identify
outbreaks, upward trends of infections, or positive effects of interventions. Intervention is an
action taken to kill pathogenic bacteria-causing disease. Surveillance, collection, and analysis
of data about infections help public health officials recognize outbreaks, upward trends of
infections, and positive effects of interventions.

OBJ: Level 1: Recall

4. Iatrogenic infections are commonly associated with

a. breaks in aseptic technique.
b. preexisting infections.
c. food-borne illness.
d. respiratory aerosol transmission.
ANS: A
Health care-associated (nosocomial) infections occur after the patient arrives (generally not
within the first 48 hours) and were not incubating in the community before the patient arrived.
They occur because of instrumentation, increased use of antimicrobial agents, breaks in
aseptic techniques, and lack of hand hygiene.

OBJ: Level 1: Recall

5. When reviewing surgical site infections, the infection control practitioner must determine if
the patient’s infection is health care–associated by considering all the following, except
a. whether an endotracheal tube was present during surgery.
b. the length of surgery.
c. the degree of contamination of the surgical site (gunshot wound to the abdomen
versus a hernia repair).
d. whether any breaks in surgical technique occurred.
ANS: A
During surgery, there is a chance that bacteria present in the environment (including
instruments) can be transferred to the surgical site and cause an infection. When put under
general anesthesia, patients usually have a tube inserted to keep their airway open. This is not
unique to any particular surgery and therefore will probably not contribute to a nosocomial
infection. The length of surgery could contribute to an infection—the longer a person’s inner
tissue is exposed to the air, the more chance there is for bacteria or fungi to get into that
wound. The degree of contamination of the surgical site may contribute to a surgical site
infection because the gut contains lots of bacteria. When it is opened up, bacteria can leak into
the sterile abdominal cavity. If there were breaks in surgical technique and a contaminated
object was introduced into the sterile area, bacteria may have transferred to the wound, and an
infection would follow.

OBJ: Level 1: Recall

6. To keep abreast of all infections that occur in the hospital, infection control practitioners set
up surveillance programs. These surveillance programs look at this parameter to determine if
there are more or fewer infections in a given period.
a. Antimicrobial susceptibility reports
b. Infection rates
 c. Handwashing rates
d. Glove usage
ANS: B
Antimicrobial susceptibility reports inform practitioners about the organisms that are resistant
to particular drugs. They do not address the number of infections in a health care facility.
Handwashing is an important part of preventing the spread of pathogens, but there is no one
who goes around and counts the number of times someone washes his or her hands. So this is
not a parameter. Glove usage is assumed to be 100%, and it does not tell the practitioner how
many infections were in the health care setting.

OBJ: Level 2: Interpretation

7. This program involves a close watch of only specific, high-risk, high-volume procedures for
nosocomial infections.
a. Baseline data
b. Total surveillance program
c. Targeted surveillance program
d. Data mining
ANS: C
Targeted surveillance programs look at particular programs for increases or decreases in
infection rates. Baseline data are used in a surveillance program and offer a marker for
comparison of subsequent data. Total surveillance programs look at all procedures for
increases or decreases in infection rates. Data mining uses sophisticated tools to analyze data.

OBJ: Level 1: Recall

8. The counties surrounding yours are seeing an increase in the number of whooping cough
cases. This is important for the microbiology laboratory because
a. physicians may start sending these cases to you.
b. you will need to advise physicians to suspect such cases and to send them to the
hospitals in the surrounding counties.
c. you need to make sure that the infection control practitioners in those counties
have baseline data.
d. you need to educate health care providers on specimen collection and
transportation, and have the specialized media ready so you can detect any cases in
your county.
ANS: D
The laboratory can be proactive in educating health care providers on specimen collection and
transportation if those are unique to a specific public health concern. Awareness of infection
control activities within the public health setting allows the laboratory to acquire the necessary
media or reagents to meet emerging needs.

OBJ: Level 2: Interpretation

9. Information that the microbiology laboratory can provide to infection control practitioners
includes
a. the prevalence of a particular pathogen.
b. data on the effectiveness of handwashing techniques.
 c. information about the outbreak of meningitis cases in the surrounding counties.
d. the antibiotic ordering patterns of particular physicians.
ANS: A
The prevalence of a particular pathogen is another piece of information that the microbiology
laboratory can provide to the infection control practitioner. Prevalence is the number of cases
of disease that occurs in a given moment in time or specific time period in a given population.
Therefore, knowing what pathogens are isolated from a given body site and being familiar
with what pathogens are frequently isolated from a given location within a health care facility
are important to the infection control practitioner.

OBJ: Level 1: Recall

10. A microbiology technologist is working at the bench and notices that a patient from the
cardiac intensive care unit (CICU) grows a Klebsiella pneumoniae bacterium that is an
extended-spectrum -lactamase-producing isolate. This technologist would advise the
physician to
a. order any antimicrobial that is effective against gram-negative rods in general.
b. limit the use of antimicrobial agents that tend to induce the formation of extended-
spectrum -lactamases.
c. draw more blood cultures, because the ones that grew that organism are
contaminated.
d. be on the lookout for diarrhea.
ANS: B
Being able to recognize what pathogens are isolated from patients in a cardiac CICU may
provide the opportunity for the infection control practitioner to inform health care providers of
the effects of antibiotic pressure. As an example, if extended-spectrum -lactamase-producing
Klebsiella pneumoniae isolates were seen in that MICU, the physicians may be advised to
limit the use of antimicrobial agents that tend to induce the formation of extended-spectrum
-lactamases.

OBJ: Level 2: Recall

11. Organisms that represent public health concerns can be recovered from patients in an acute
care hospital. All of the following isolates are considered significant or major public health
concerns that are reportable to public health jurisdictions to follow up as a potential outbreak,
except
a. Neisseria meningitis.
b. West Nile virus.
c. MRSA.
d. encephalitis viruses.
ANS: C
Although MRSA can be an infection control issue within a health care facility, it is not yet
considered a significant public health concern. Methicillin-resistant S. aureus is usually born
and bred in a health care setting, but more cases of community-acquired MRSA are being
seen. The other organisms are spread by mosquitoes and close contact.

OBJ: Level 1: Recall

12. Organisms that are frequently encountered as causes of health care-associated infections in
acute care settings include all the following organisms, except
a. MRSA.
b. enterococci.
c. Clostridium difficile.
d. Neisseria meningitis.
ANS: D
N. meningitis is usually not implicated in health care-associated infections. These infections
are usually outbreaks that occur in the community, especially in schools.

OBJ: Level 1: Recall

13. Patients in both extended care facilities and home care settings are frequently
immunosuppressed by disease or therapy and often need intravascular or other device-related
care. The microbes identified in these patients are often opportunistic pathogens and include
all the following, except
a. Pseudomonas aeruginosa.
b. Neisseria meningitis.
c. Candida.
d. Acinetobacter.
ANS: B
Infectious etiologic agents of infection control significance identified in these patients include
P. aeruginosa, Candida, Staphylococcus aureus, Acinetobacter, Clostridium difficile,
methicillin-resistant Staphylococcus, and vancomycin-resistant enterococci.

OBJ: Level 2: Interpretation

14. Prisoners or people housed in behavioral health facilities are more likely to contract infections
with pathogens from their intimate contact with blood and body fluids. A likely pathogen may
be
a. Pseudomonas aeruginosa.
b. Hepatitis C.
c. Methicillin-resistant Staphylococcus aureus (MRSA).
d. Clostridium difficile.
ANS: B
People who are housed together in some form of communal living, such as prisons or
behavioral health facilities, have infection control-related infections similar to the other
settings previously described. The infectious diseases are more likely related to the activities
of the persons within the facility. As an example, MRSA is recovered from prisoners who
practice illicit tattooing with nonsterile, shared equipment, whereas lice and hepatitis C are
more frequently seen in behavioral health settings because of the community source of the
clients and their intimate contact with blood and body fluids.

OBJ: Level 1: Recall

15. An outbreak occurs when

a. numbers of isolates or infection rates increase significantly above the baseline.
b. numbers of isolates or infection rates decrease significantly below the baseline.
 c. many people in a community are infected with a particular organism.
d. the mortality rate from a particular organism increases above 2%.
ANS: A
When numbers of isolates or infection rates increase above the baseline or when an isolate of
a rare or potential bioterrorism agent is recovered, an “outbreak” may have occurred. The
microbiology laboratory may be the first to recognize that event and will likely participate in
the investigation of that outbreak.

OBJ: Level 1: Recall

16. An index case is

a. an epidemiologic curve for a particular pathogen.
b. the last case described in an outbreak.
c. the first case described in an outbreak.
d. the case where the number of infections with a particular organism rises above the
baseline.
ANS: C
The first case described is the index case, and the other infections that followed were to be
determined if they were related to that first case.

OBJ: Level 1: Recall

17. When an outbreak is suspected, all the following steps are taken in investigating that event,
except
a. establishing a case definition.
b. confirming that an outbreak exists.
c. immediately treating all persons involved with appropriate antibiotic.
d. establishing an epidemiologic curve.
ANS: C
First establish a case definition, and then confirm that an outbreak exists. One must be certain
that all the suspected cases match the definition and that there are more than an expected
number of cases. Additional cases may be added to the initial number of cases. Next, pull
together as much information about the cases as possible, related to person, place, or time,
then draw an epidemiologic curve. Then form a hypothesis about the likely reservoir, source,
and means of transmission. At any point along the timeline, establish interventions to stop the
outbreak.

OBJ: Level 1: Recall

18. In an outbreak investigation and in the collection of routine surveillance data, what sorts of
activities are critical?
a. Microbiologists’ awareness of the processes that occur in a routine investigation
b. Alerting the public health department about potential outbreaks
c. Analyzing data on antimicrobial susceptibility from pathogens in the hospital so
the health care providers understand the type of antimicrobials that must be used
d. Collecting, processing, reporting, and reviewing pertinent cultures
ANS: D
 In an outbreak investigation and in the collection of routine surveillance data, the collection,
processing, reporting, and reviewing of pertinent cultures become critical. The availability of
culture reviews that may result in the initiation or termination of an outbreak investigation
cannot be overlooked in importance. These data form the basis for the decisions made at each
step of the investigation of an outbreak.

OBJ: Level 1: Recall

19. If a large statewide or worldwide epidemic occurs, one of the major difficulties is
a. collecting and transporting specimens from people who live out of state or around
the world.
b. determining what organism is causing the outbreak.
c. arranging to get all the people with the infections to come back to the main area of
the outbreak for an extended period.
d. making sure enough media and technologists are available to process the large
amount of cultures associated with the outbreak investigation.
ANS: A
One of the major difficulties in a large outbreak is the ability to collect and transport
specimens from patients who live out of the area. Some of the individuals may have had their
cultures processed in their home state or country so that results from those cultures are
difficult to retrieve.

OBJ: Level 1: Recall

20. What is pulsed-field gel electrophoresis?

a. The process of performing various environmental cultures to aid in infection
control investigations
b. A strain-typing technique that can be an important adjunct to epidemiologic
investigations
c. A culture technique that compares the two antibiograms of an isolate with the
index case
d. A technique that checks for water quality
ANS: B
Pulsed-field gel electrophoresis enables a microbiology technologist to determine the strain of
an organism. Knowing the strain is important because, in an outbreak, the same strain of
organism is causing the problem. If the strain can be identified, the index case can be found,
and the outbreak can be stopped. This strain typing technique is more sensitive than
comparing antibiograms.

OBJ: Level 1: Recall

21. Although environmental cultures are not usually performed because the environment is rarely
implicated in disease transmission, they occasionally are useful. Samples will be taken from
all of the following, except
a. air.
b. water.
c. hands.
d. surfaces.
 ANS: C
Recommendations surrounding environmental infection control have been extensively
discussed in a Centers for Disease Control and Prevention (CDC) document. The environment
is rarely implicated in disease transmission, except with immunosuppressed patients. The air,
water, and surfaces are cultured when appropriate. Hands may transmit pathogens, but they
are not considered part of the environment.

OBJ: Level 1: Recall

22. Waterborne illnesses that may be associated with contaminated drinking water or recreation
water include all the following, except
a. legionellosis.
b. hepatitis A.
c. Pseudomonas skin infection.
d. hepatitis B.
ANS: D
Hepatitis B is a blood-borne pathogen and cannot be contracted from contaminated water.
Waterborne diseases include respiratory illnesses (such as legionellosis), hepatitis (hepatitis A
or hepatitis E), skin infections (from Pseudomonas or mycobacteria), and central nervous
system infections (Naegleria).

OBJ: Level 1: Recall

23. In the United States, 46 outbreaks annually owing to waterborne pathogens cause this illness
and affect several thousand people.
a. Diarrhea
b. Hepatitis C
c. Naegleria
d. Legionnaires’ disease
ANS: A
These outbreaks can be due to Giardia lamblia, Escherichia coli, the Norwalk virus, Norwalk-
like viruses, and other viruses associated with diarrhea. Hepatitis C is a blood-borne pathogen.
Infection with Naegleria affects the brain and is relatively rare. Legionnaires’ disease is a
respiratory illness.

OBJ: Level 1: Recall

24. The role of the microbiology laboratory is to perform cultures and provide culture results to
health care providers. The microbiology laboratory also has the responsibility to
a. report the identification or suspicion of certain infectious diseases to local, state,
and federal public health entities.
b. report any bioterrorism findings to the news media.
c. report odd infectious diseases to the CDC.
d. report any bioterrorism finding to the police.
ANS: A
 Because of the escalation of terrorism in the United States and the distinct possibility of a
widespread bioterrorism attack, it is imperative that the laboratory technologist knows what
infectious diseases are reportable, to what agency they are to be reported, and in what time
frame they are to be reported. The identification or suspicion of certain infectious diseases
will need to be reported to particular government agencies to begin an investigation. If these
reports are not made, no one will know of the possibility of an outbreak or a bioterrorism
attack. Laboratory technologists need to follow the policies of their laboratory for notification.

OBJ: Level 1: Recall

25. The hospital infection control committee will expect reports from the laboratory that deal with
all the following, except
a. antibiograms.
b. water contamination rates.
c. blood culture contamination rates.
d. pathogens recovered in certain hospital units.
ANS: B
Committees review the results and note any trends that may be occurring. This is important so
that outbreaks may be caught early while they are still manageable. Water contamination rates
are never included in these periodic reports because routine environmental cultures are not
performed in the hospital. Antibiograms, blood culture contamination rates, and pathogens
recovered in certain hospital units are extremely important when looking for outbreaks.

OBJ: Level 1: Recall

26. Laboratory technologists must not only keep themselves educated in their contribution to the
infection control team, they must keep
a. housekeeping alerted as to the nature of the microbiology laboratory’s
biohazardous waste.
b. laboratory management aware of equipment needs.
c. the infection control personnel educated regarding the laboratory’s contribution to
the team.
d. the Centers for CDC informed of the continuing education needs of the
microbiology laboratory’s staff.
ANS: C
The infection control team needs to know the types of contributions the microbiology
laboratory can make. When new procedures or new equipment are added to the laboratory,
personnel need to know what new type of information is now available to the infection control
team. New information may make discovering outbreaks easier and quicker. Housekeeping
knows that the microbiology laboratory’s waste is biohazardous and treats it as such. The
housekeeping team has no need to know exactly what is in the bags. Laboratory management
monitors workload and new equipment, so the supervisory team would keep track of the
equipment needs of the department. The CDC does not need to be notified of the
microbiology laboratory staff’s continuing education needs.

OBJ: Level 1: Recall

27. This is practiced throughout the hospital and mandates safety for all personnel when handling
blood and body fluids.
 a. Biosafety level 2
b. Handwashing
c. Wearing of respirators
d. Standard Precautions
ANS: D
Standard Precautions are used by all hospital personnel to prevent infection with blood-borne
pathogens. This is mandated by the Occupational Safety and Health Administration (OSHA).
Handwashing is also practiced throughout the hospital when hands become soiled, but this is
used for everything, not just when handling blood and body fluids. Biosafety level 2
precautions are practiced only in the laboratory, not throughout the hospital. Wearing of
respirators is used in biosafety level 3 and level 4 precautions. Respirators are usually only
worn in the laboratory and not throughout the hospital.

OBJ: Level 1: Recall

28. What types of activities have led to the emergence of the microbiology laboratory as the
forefront in keeping Americans safe?
a. Terrorist
b. Research
c. Military
d. Educational
ANS: A
With the advent of terrorist activities in the world, the microbiology laboratory has become an
integral part of that area of the infection control program. Whether dealing with emerging
diseases, such as severe acute respiratory syndrome (SARS), or reemerging disease, such as
anthrax, the laboratory must stay closely aligned with the infection control activities in the
setting that the laboratory serves. Hospital laboratories will be the first point of contact for
cultures of infected people.

OBJ: Level 1: Recall

29. An example of an emerging disease is

a. influenza.
b. West Nile virus.
c. malaria.
d. chicken pox.
ANS: B
West Nile virus is a zoonotic virus that is slowly beginning to infect humans. This disease has
been diagnosed in humans since the late 1990s. Influenza has been around for many years—
one of the worse outbreaks was in 1916. Malaria has been around in the tropics since the
Europeans began invading South America and Africa. Chicken pox is a common virus, so
common that a vaccine was developed to ward off infection in the 1960s.

OBJ: Level 1: Recall