* Perioperative normothermia maintenance reduces SSI rates by improving immune function and tissue perfusion.
* Routine wound irrigation (B) has no strong evidence supporting SSI prevention.
* Prolonged antibiotic use (C) increases antibiotic resistance without added benefit.
* Extended use of wound dressings (D) does not reduce SSI rates.
CBIC Infection Control References:
* APIC Text, "SSI Prevention in Surgery," Chapter 12.

The optimal specimen for identifying the etiologic agent in a prosthetic joint infection (PJI) is a joint aspirate (synovial fluid). This is because:
* It provides direct access to the infected site without contamination from external sources.
* It allows for accurate microbiologic culture, Gram stain, and leukocyte count analysis.
Why the Other Options Are Incorrect?
* A. Blood - Blood cultures may help detect hematogenous spread but are not the best sample for identifying localized prosthetic joint infections.
* B. Wound drainage - Wound cultures often contain contaminants from surrounding skin flora and do not accurately reflect joint space infection.
* D. Sinus tract tissue - Cultures from sinus tracts often represent colonization rather than the primary infecting organism.
CBIC Infection Control Reference
APIC guidelines confirm that joint aspirate is the most reliable specimen for diagnosing prosthetic joint infections.

The correct answer is D, "Hepatitis B immune globulin (HBIG) and hepatitis B vaccine," as this is the recommended regimen for an HBsAb-negative employee with a percutaneous exposure to blood from an HBsAg-positive patient. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines, which align with recommendations from the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), post-exposure prophylaxis (PEP) for hepatitis B virus (HBV) exposure depends on the employee's vaccination status and the source's HBsAg status. For an unvaccinated or known HBsAb-negative individual (indicating no immunity) exposed to HBsAg-positive blood, the standard PEP includes both HBIG and the hepatitis B vaccine. HBIG provides immediate passive immunity by delivering pre-formed antibodies, while the vaccine initiates active immunity to prevent future infections (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.2 - Implement measures to prevent transmission of infectious agents). The HBIG should be administered within 24 hours of exposure (preferably within 7 days), and the first dose of the vaccine should be given concurrently, followed by the complete vaccine series.
Option A (immune serum globulin and hepatitis B vaccine) is incorrect because immune serum globulin (ISG) is a general immunoglobulin preparation and not specific for HBV; HBIG, which contains high titers of anti-HBs, is the appropriate specific immunoglobulin for HBV exposure. Option B (hepatitis B immune globulin [HBIG] alone) is insufficient, as it provides only temporary passive immunity without initiating long- term active immunity through vaccination, which is critical for an unvaccinated individual. Option C (hepatitis B vaccine alone) is inadequate for immediate post-exposure protection, as it takes weeks to develop immunity, leaving the employee vulnerable in the interim.
The recommendation for HBIG and hepatitis B vaccine aligns with CBIC's emphasis on evidence-based post- exposure management to prevent HBV transmission in healthcare settings (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.1 - Collaborate with organizational leaders).
This dual approach is supported by CDC guidelines, which prioritize rapid intervention to reduce the risk of seroconversion following percutaneous exposure (CDC Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV, 2013).
References: CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competencies 3.1 - Collaborate with organizational leaders, 3.2 - Implement measures to prevent transmission of infectious agents. CDC Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV, 2013.

The correct answer is B, "The sterility is not maintained during storage," as this represents a key limitation of using liquid chemical sterilants to sterilize medical items. According to the Certification Board of Infection Control and Epidemiology (CBIC) guidelines and standards from the Association for the Advancement of Medical Instrumentation (AAMI), liquid chemical sterilants, such as glutaraldehyde or peracetic acid, are effective for sterilizing heat-sensitive medical devices by eliminating all forms of microbial life, including spores, when used according to manufacturer instructions (CBIC Practice Analysis, 2022, Domain III:
Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment).
However, a significant limitation is that sterility is not guaranteed after the items are removed from the sterilant and stored, as the sterile barrier can be compromised by environmental contamination, improper packaging, or handling (AAMI ST58:2013, Chemical Sterilization and High-Level Disinfection in Health Care Facilities).
Option A (it does not kill the spores) is incorrect because liquid chemical sterilants are designed to achieve sterilization, including the destruction of bacterial spores, provided the contact time, concentration, and conditions specified by the manufacturer are met. Option C (it requires a contact time of at least 12 hours) is not a universal limitation; while some liquid sterilants require extended contact times (e.g., 10-12 hours for certain formulations), this is a procedural requirement rather than an inherent limitation, and shorter times may be sufficient with other agents or automated systems. Option D (it can only be used for heat tolerant devices) is incorrect because liquid chemical sterilants are specifically intended for heat-sensitive devices that cannot withstand steam or dry heat sterilization.
The limitation of sterility not being maintained during storage underscores the need for immediate use of sterilized items or the use of proper sterile packaging and storage protocols to prevent recontamination. This aligns with CBIC's focus on ensuring the safety and efficacy of reprocessed medical equipment in infection prevention (CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment). Healthcare facilities must implement strict post-sterilization handling and storage practices to mitigate this limitation.
References: CBIC Practice Analysis, 2022, Domain III: Infection Prevention and Control, Competency 3.3 - Ensure safe reprocessing of medical equipment. AAMI ST58:2013, Chemical Sterilization and High-Level Disinfection in Health Care Facilities.

Coliform bacteria are indicators of fecal contamination in water, making them a critical measure of water safety. Hepatitis A is a virus primarily transmitted via the fecal-oral route, often through contaminated food or water.
Step-by-Step Justification:
* Fecal Contamination and Hepatitis A:
* Hepatitis A virus (HAV) spreads through ingestion of water contaminated with fecal matter. High coliform counts indicate fecal contamination and increase the risk of HAV outbreaks.
* Use of Coliforms as Indicators:
* Public health agencies use total coliforms and Escherichia coli (E. coli) as primary indicators of water safety because they signal fecal pollution.
* Waterborne Transmission of Hepatitis A:
* Hepatitis A outbreaks have been traced to contaminated drinking water, ice, and improperly treated wastewater. Coliform detection signals a need for immediate action.
Why Other Options Are Incorrect:
* B. Pseudomonads:
* Pseudomonads (e.g., Pseudomonas aeruginosa) are environmental bacteria but are not indicators of fecal contamination.
* C. Legionella:
* Legionella species cause Legionnaires' disease through inhalation of contaminated aerosols, not through fecal-oral transmission.
* D. Acinetobacter:
* Acinetobacter species are opportunistic pathogens in healthcare settings but are not indicators of waterborne fecal contamination.
CBIC Infection Control References:
* APIC Text, "Water Systems and Infection Control Measures".
* APIC Text, "Hepatitis A Transmission and Waterborne Outbreaks".