1. Multidrug-resistant organisms (MDROs) are defined as microorganisms that are resistant to one or more classes of antimicrobial agents. These organisms are:

• a. Predominantly viruses and fungi.
• b. Usually resistant to only one class of antibiotics.
• c. Not treatable with any antibiotic.
• d. Predominantly bacteria.

2. MDROs have been linked to:

• a. Poverty, overcrowded living conditions, and malnutrition.
• b. Increased lengths of stay, increased costs, and even mortality.
• c. Insufficient use of the array of antibiotics available today.
• d. Sexual contact with more than six individuals over the past year.

3. Multidrug-resistant S. aureus (MRSA) may behave differently from other multidrug-resistant organisms. Please select the one false statement below.

• a. MRSA-colonized patients more frequently develop symptomatic infections.
• b. Higher case fatality rates have been observed for certain MRSA infections.
• c. Some hospitals have reported a decrease in staph infections following the introduction of MRSA.
• d. There may be an association between MRSA infections and increased length of stay.

4. Selective pressure refers to:

• a. Any phenomena that alter the behavior of living organisms and influence their survival.
• b. The targeting of healthcare personnel in attempts to explain growing infection rates.
• c. Any phenomenon that targets a particular organism.
• d. An array of settings on equipment used to treat laboratory cultures.

5. Once multidrug-resistant organisms are introduced into a healthcare setting, transmission and persistence of the resistant strain is determined by several factors. One of those factors is:

• a. The size of the healthcare facility
• b. The number of blood transfusions performed in the hospital
• c. The availability of vulnerable patients
• d. The type and number of surgeries performed

6. Colonization pressure is:

• a. Population expansion into sparsely settled areas.
• b. Pressure to create satellite healthcare facilities in expanding rural areas.
• c. Pressure to create more long-term care facilities as the populations ages.
• d. Increased potential for transmission of MDROs as the proportion of colonized patients increases.

7. The risk than an ICU patient will acquire VRE increases significantly when:

• a. More than 50% of the patients have it or they have been exposed for >15 days.
• b. They have had more than five courses of vancomycin.
• c. They have been blood donors for more than five years.
• d. Staff is lax in reporting incidents to the health department.

8. All of the following have been shown to increase transmission rates in healthcare facilities except:

• a. Poor hand hygiene practices among healthcare workers.
• b. Greater than 15 days of exposure to an MDRO in an ICU.
• c. Patients receiving care at multiple healthcare facilities.
• d. Increased adherence to and monitoring of hand hygiene guidelines.

9. Healthcare personnel are primarily responsible for the transmission of MDROs from patient to patient.

• a. True
• b. False

10. Community-associated MRSA (CA-MRSA) is distinct from that found in the hospital setting. Which statement about CA-MRSA is true?

• a. Transmission of CA-MRSA is being reported in hospitals with increasing frequency.
• b. CA-MRSA likely arose in the healthcare setting and moved into the community.
• c. CA-MRSA commonly presents as a severe skin or soft-tissue infection.
• d. There is really no connection between MRSA strains in hospitals and CA-MRSA.

11. Prevention and control of MDROs depend upon several key elements. These include all of the following except:

• a. Infection prevention.
• b. Accurate and prompt diagnosis and treatment.
• c. Liberal use of antimicrobials.
• d. Transmission prevention.

12. It has not been possible to determine the effectiveness of individual interventions, or a specific combination of interventions, that would be appropriate for all healthcare facilities in controlling their target MDROs.

• a. True
• b. False

13. Which one statement about judicious use of antimicrobials is true?

• a. Limiting antimicrobial use is a good way to control resistance.
• b. Treat contaminants, not infections.
• c. Avoid excessive duration of therapy.
• d. If the pathogen is not known, treat aggressively with broad-spectrum antimicrobials.

14. The simplest form of MDRO surveillance is by:

• a. Monitoring microbiology isolates that result from tests ordered during routine clinical care.
• b. Obtaining skin and nasal cultures from all hospitalized patients upon admission.
• c. Sending all hospital microbiology isolates reports to a regional lagoratory for review.
• d. Obtaining yearly nasal, skin, and rectal cultures from hospital personnel.

15. Surveillance is an important part of an MDRO control program for all of the following reasons except:

• a. Detection of newly emerging pathogens.
• b. Monitoring epidemiologic trends.
• c. Identifying healthcare workers colonized with an MDRO.
• d. Measuring the effectiveness of interventions.

16. Studies suggest that most patients with MRSA can be identified by culturing their:

• a. Skin.
• b. Nares.
• c. Urethra.
• d. Sputum.

17. Active surveillance cultures refers to:

• a. Surveillance cultures ordered by the health department.
• b. Routine cultures of MDROs.
• c. Use of routine culturing to monitor spread and isolation of colonized patients.
• d. Cultures of police, fire, and other first responder personnel.

18. In one study, use of gloves when in contact with MDRO patients:

• a. Had no effect on the control of MDROs.
• b. Was no better than results from improved adherence to hand hygiene practices.
• c. Improved control of MDROs.
• d. Had no effect, but improved morale of healthcare personnel.

19. Standard Precautions:

• a. Have an essential role in preventing MDRO transmission.
• b. Are not needed when contact precautions are used.
• c. Are used only when a MDRO has been positively identified.
• d. Are not necessary in facilities using ASC.

20. In general, it seems reasonable to discontinue Contact Precautions when:

• a. A single surveillance culture is negative and the patient is transferred from a private room to a shared room.
• b. Three or more surveillance cultures are negative over the course of 1–2 weeks in a patient who has not received antimicrobial therapy for several weeks.
• c. The surveillance culture is negative even in the presence of draining wound or respiratory secretions.
• d. It is never prudent to discontinue Contact Precautions.

21. Some studies show patients who are placed on Contact Precaution isolation:

• a. Have decreased anxiety and depression scores.
• b. Express greater satisfaction with their treatment.
• c. Have less documented care then control patients.
• d. Have less preventable adverse reactions.

22. Which of the following environmental measures have been shown to control transmission of MDROs and other pathogens in the environment?

• a. Surveillance of potentially infected healthcare workers
• b. Routine use of antimicrobial cleaning solutions
• c. Monitoring for adherence to recommended environmental cleaning practices
• d. Routine use of negative pressure isolation rooms

23. Decolonization is:

• a. Not effective for person carrying MRSA in their nares.
• b. Sufficiently effective to warrant routine use.
• c. Treatment of persons colonized with a specific MDRO, usually MRSA, to eradicate carriage of that organism.
• d. Not recommended for healthcare personnel implicated in transmission of MRSA.

24. Control programs that focus on only one organism or one antimicrobial drug are unlikely to succeed because:

• a. Vulnerable patients will continue to serve as a magnet for other MDROs.
• b. More than one organism is always present in vulnerable patients.
• c. It is not possible to isolate one organism.
• d. Vulnerable patients probably have several undetectable organisms.

25. Because of a lack of evidence-based research on controlling MDROs in healthcare facilities:

• a. Administrators should wait until more evidence is available before starting a prevention program.
• b. Interventions should be based on assessments of the local problem, the prevalence of various MDROs, and feasibility.
• c. Contact Precautions should be emphasized rather than ASC.
• d. There is no pressing need for smaller facilities to copy procedures used at larger facilities.