CBIC CIC Cheat Sheet

Identification of Infectious Disease Processes

16.3% of exam
Chain of Infection Disease Process Concepts Test Performance Measures Colonization vs Infection

Surveillance and Epidemiologic Investigation

16.3% of exam
Epidemiology Measures NHSN HAI Concepts Outbreak Investigation Toolkit Surveillance Metric Picker

Preventing/Controlling Transmission

16.3% of exam
Precaution Categories PPE Rules Hand Hygiene Organism Precaution Map Precaution Picker

Employee/Occupational Health

8.1% of exam
OSHA Bloodborne Numbers Exposure Follow-up TB Screening Program Respirator Rules

Management, Communication, Education

10.4% of exam
Program and Regulation Risk Assessment Stewardship Core Elements Cost Avoidance

Education and Research

8.9% of exam
Education and Research Adult Learning Evidence Hierarchy Competency Validation

Environment of Care

10.4% of exam
Environment of Care ACH Clearance Times Construction ICRA Water Management

Cleaning, Disinfection, Sterilization

13.3% of exam
Spaulding Classification Disinfection Levels and Agents Sterilization Monitoring Reprocessing Picker

Quick Facts

Credential CIC
Board CBIC
Items 150 (135 scored)
Time 3 h, two sections
Navigation Forward only, no flags
Pass Scaled 700 (300-900)
Pass rate 64% in 2025
Fee $445 application
Delivery Prometric / ProProctor
Retake 90 days, max 4/year
Valid 5 years, 40 IPUs
Outline 2021, new Feb 2027

Chain of Infection ID

Agent, Reservoir, Exit, Mode, Entry, Host
Agent: the pathogen Reservoir: where it lives Exit: how it leaves Mode: how it travels Entry: how it arrives Host: who is susceptible

Sensitivity vs Specificity ID

Sensitivity

True positive rate
Negative rules out
Prevalence independent

Specificity

True negative rate
Positive rules in
Prevalence independent
Catch sick vs confirm sick

Chain of Infection ID

Infectious agent Pathogen causing disease
Reservoir Where the agent lives
Portal of exit How the agent leaves
Mode of transmission Contact, droplet, airborne, vehicle
Portal of entry How it enters host
Susceptible host Person at risk
Break any link Transmission stops Key

Colonization vs Infection ID

Colonization

No tissue invasion
No clinical signs
Can still transmit

Infection

Tissue invasion
Host response present
Counted as case
Present vs invading

Disease Process Concepts ID

Colonization Present, no tissue invasion
Infection Invasion plus host response
Contamination Organism on surface only
Pseudo-outbreak Lab artifact, no illness
Incubation period Exposure to first symptom
Communicable period Window of transmissibility
Virulence Severity of disease produced
Infectivity Ability to enter, multiply
Pathogenicity Share of infected sickened

Test Performance Measures ID

Sensitivity True positive rate
Specificity True negative rate
SnNout Sensitive test rules out
SpPin Specific test rules in
PPV Positive means true disease
NPV Negative means truly well
Prevalence effect Low prevalence lowers PPV
Diagnostic stewardship Test only symptomatic patients

Epi Curve Shapes SU

Spike, plateau, waves
Spike: point source Plateau: continuous source Waves: propagated spread

Incidence vs Prevalence SU

Incidence

New cases only
Population at risk
Measures risk

Prevalence

New plus existing
Point or period
Measures burden
Risk vs burden

Surveillance Metric Picker SU

Measuring new HAI risk → Incidence rate ( Per 1,000 device days )
Snapshot of burden → Point prevalence ( One day count )
Comparing to national baseline → SIR ( Observed over predicted )
Judging device use → SUR ( Device days ratio )
Foodborne cluster on unit → Attack rate ( Ill over exposed )
Fewer than 1 predicted → No SIR reported ( Estimate unstable )
Linking cases to strain → Molecular typing ( Confirms relatedness )

Epidemiology Measures SU

Incidence New cases, population at-risk
Prevalence All cases, one time
Attack rate Ill divided by exposed
Device utilization ratio Device days over patient days
Device-associated rate Infections per 1,000 device days
SIR Observed over predicted infections
SUR Observed over predicted device days
Point prevalence survey Snapshot on one day
Denominator Population or days at-risk

NHSN HAI Concepts SU

CLABSI Line >2 days, no source
CAUTI Catheter >2 days plus symptoms
SSI Infection after operative procedure
SSI window 30 or 90 days
VAC Sustained oxygenation worsening
IVAC VAC plus fever, antimicrobial
PVAP IVAC plus qualifying microbiology
Date of event First qualifying element appears
Present on admission Not counted as HAI
LabID event Lab-based MDRO or C. difficile

Outbreak Investigation Toolkit SU

Confirm outbreak Compare against baseline rate
Case definition Person, place, time, criteria
Line list One row per case
Epi curve Cases plotted over time
Point source Single sharp peak
Continuous source Plateau while exposure persists
Propagated Peaks one incubation apart
Analytic study Case-control or cohort
Molecular typing Confirms strain relatedness
Control measures Start before study finishes Trap

Five Moments PR

Patient, aseptic, fluid, patient, surroundings
1: before touching patient 2: before aseptic task 3: after fluid risk 4: after touching patient 5: after touching surroundings

Airborne vs Droplet PR

Airborne

Small particles, long distance
N95 respirator
Negative pressure room

Droplet

Large droplets, short range
Surgical mask
Normal room, door open
Respirator vs surgical mask

Precaution Picker PR

Suspected pulmonary tuberculosis → Airborne ( N95, AIIR, door closed )
Measles → Airborne ( Immune staff preferred )
Varicella → Airborne plus contact ( Both, not contact alone )
Disseminated zoster → Airborne plus contact ( Any immune status )
Localized zoster, immunocompetent → Standard ( Cover the lesions )
Influenza or pertussis → Droplet ( Surgical mask on entry )
Neisseria meningitidis → Droplet ( Not airborne )
Mumps or rubella → Droplet ( Not airborne )
C. difficile → Contact ( Soap, water, bleach )
Norovirus outbreak → Contact ( Alcohol rub insufficient )
MRSA, VRE, CRE → Contact ( Gown and gloves )
RSV in infant → Contact ( Add droplet if splashing )
Stem cell transplant patient → Protective environment ( Positive pressure room )

Precaution Categories PR

Standard Every patient, every time
Contact Gown and gloves
Droplet Surgical mask on entry
Airborne N95 plus negative-pressure room
Protective environment Positive pressure, HEPA supply
Layering rule Transmission-based adds to standard

Doffing Order PR

Gloves, gown, eyewear, mask last
Dirtiest comes off first Mask outside the room Hand hygiene immediately after

PPE Rules PR

Donning order Gown, mask, eyewear, gloves
Doffing order Gloves, gown, eyewear, mask
Mask removal Outside the room
Gloves Never replace hand hygiene
N95 Fit-tested, seal check each use
Gown Fluid-resistant, single patient use
Eye protection Goggles or face shield
Patient transport Patient wears the mask

Hand Hygiene PR

Moment 1 Before touching a patient
Moment 2 Before clean, aseptic procedure
Moment 3 After body fluid risk
Moment 4 After touching a patient
Moment 5 After touching patient surroundings
Alcohol rub Preferred, faster, less drying
Soap and water Visibly soiled, spores, norovirus
Artificial nails Prohibited in high-risk units

Organism Precaution Map PR

Tuberculosis Airborne
Measles Airborne
Varicella Airborne plus contact
Disseminated zoster Airborne plus contact
Localized zoster, immunocompetent Standard, cover lesions
Influenza Droplet
Pertussis Droplet
Neisseria meningitidis Droplet Trap
Mumps, rubella Droplet
C. difficile Contact plus soap
Norovirus Contact
RSV Contact
MRSA, VRE, CRE Contact
Scabies, lice Contact

OSHA Bloodborne Numbers OC

Standard 29 CFR 1910.1030
Exposure control plan Reviewed at least annually
Hepatitis B vaccine Free within 10 working days
Training At assignment, then annually
Sharps injury log Employers over 10 employees
Medical records Employment plus 30 years
Training records Kept 3 years
Device selection Frontline worker input required

Exposure Follow-up OC

HIV PEP Start hours, take 28 days
HBV, unvaccinated source-positive HBIG plus vaccine series
HBV timing Ideally within 24 hours
Hepatitis C No PEP, test and treat
Anti-HBs immunity At least 10 mIU/mL
Source testing Test source, consent permitting
Sharps injury Wash, report, evaluate promptly

TB Screening Program OC

Baseline Risk assessment, symptoms, test
Baseline TST Two-step when TST used
IGRA Blood test, one visit
Routine annual testing No longer recommended Updated
Annual education Required for all personnel
After exposure Test baseline, 8-10 weeks
Fit test Before use, then annually

Program and Regulation MA

Risk assessment Ranks risks by priority
IPC plan Goals from ranked risks
CMS Conditions of Participation Enforceable federal requirement
Joint Commission Voluntary, may carry deemed status
CDC/HICPAC guidelines Recommendations, not law
Stewardship core elements Seven CDC hospital elements
Cost avoidance Infections prevented times cost
Cost savings Real budget line reduction
PDSA Plan, Do, Study, Act

Education vs Competency Validation ED

Education

Transfers knowledge
Attendance or post-test
Classroom or module

Competency validation

Observed performance
Defined criteria
Return demonstration
Knows vs can do

Education and Research ED

Andragogy Adults are self-directed learners
Readiness to learn Driven by role demands
Education Knowledge, measured by post-test
Competency validation Observed return demonstration
Cognitive domain Knowledge and reasoning
Psychomotor domain Physical skill performance
Affective domain Attitudes and values
Evidence hierarchy top Systematic review of RCTs
Research trigger Intent to generalize knowledge
Quality improvement Local, usually no IRB

AIIR vs Protective Environment EN

AIIR

Negative pressure
Protects everyone else
Infectious patient inside

Protective environment

Positive pressure
Protects the patient
HEPA-filtered supply air
Keep in vs keep out

Environment of Care EN

AIIR Negative pressure, door closed
AIIR air changes 12 new, 6 existing
Pressure monitoring Daily while room occupied
Protective environment Positive pressure, HEPA supply
ICRA matrix Activity type by patient risk
Aspergillus risk Construction dust, immunocompromised patients
Water management ASHRAE 188 Legionella program
Legionella conditions Stagnation, tepid water, low residual
Contact time Surface stays visibly wet
Bleach for C. difficile 1:10 dilution, EPA List K
Regulated medical waste Pourable, drippable, caked blood

ACH Clearance Times EN

2 ACH, 99% 138 minutes
6 ACH, 99% 46 minutes
6 ACH, 99.9% 69 minutes
12 ACH, 99% 23 minutes
12 ACH, 99.9% 35 minutes
15 ACH, 99.9% 28 minutes
20 ACH, 99.9% 21 minutes
Use Wait time after airborne case

Spaulding C-S-N RE

Critical sterilize, Semicritical high-level, Noncritical low-level
Critical: sterile tissue Semicritical: mucous membranes Noncritical: intact skin

High-level Disinfection vs Sterilization RE

High-level disinfection

Many spores survive
Semicritical devices
Liquid chemical, minutes

Sterilization

All spores killed
Critical devices
Validated, monitored cycle
Spores survive vs none

Reprocessing Picker RE

Visibly soiled instrument → Clean first ( Soil blocks sterilants )
Enters sterile tissue → Sterilize ( Critical item )
Enters the bloodstream → Sterilize ( Implants, surgical instruments )
Touches mucous membranes → High-level disinfection ( Semicritical item )
Flexible GI endoscope → High-level disinfection ( Leak test, brush channels )
Bronchoscope → High-level disinfection ( Sterilize when feasible )
Covered vaginal probe → High-level disinfection ( Cover is not enough )
Touches intact skin → Low-level disinfection ( Noncritical item )
Blood pressure cuff → Low-level disinfection ( EPA-registered wipe )
Needed immediately, no spare → IUSS ( Never routine implants )

Spaulding Classification RE

Critical Sterile tissue or bloodstream
Critical process Sterilization required
Semicritical Contacts mucous membranes
Semicritical process High-level disinfection minimum
Noncritical Intact skin only
Noncritical process Low-level disinfection
Class driver Intended use, not name Trap
Cleaning first Always precedes disinfection, sterilization

BI Spore Match RE

Steam Geobacillus, dry heat Bacillus
Geobacillus: steam sterilization Geobacillus: hydrogen peroxide Bacillus atrophaeus: dry heat Bacillus atrophaeus: ethylene oxide

Biological vs Chemical Indicator RE

Biological indicator

Live resistant spores
Proves lethality
Releases implant loads

Chemical indicator

Color change
Proves exposure only
Never proves sterility
Killed vs exposed

Disinfection Levels and Agents RE

High-level Kills all but many spores
High-level agents Glutaraldehyde, OPA, peracetic acid
Intermediate-level Tuberculocidal claim, no spores
Intermediate agents Alcohol, phenolics, iodophors, chlorine
Low-level Vegetative bacteria, some viruses
Low-level agents Quaternary ammonium compounds
Dividing line Tuberculocidal separates intermediate, low
Sterilization Kills all microbial life

Sterilization Monitoring RE

Biological indicator Only proof of lethality
Steam, hydrogen peroxide Geobacillus stearothermophilus
Dry heat, ethylene oxide Bacillus atrophaeus
Chemical indicator Proves exposure, not sterility
Bowie-Dick Daily air removal test
Bowie-Dick setup Empty chamber, first cycle
Gravity steam 121 C, 30 minutes wrapped
Prevacuum steam 132 C, 4 minutes wrapped
IUSS Emergency only, never implants Trap
Implant loads Quarantine until BI result
Event-related sterility Package integrity, not date

Common Traps

Droplet is not airborne

Meningococcus, pertussis: droplet ≠ Tuberculosis, measles: airborne

Varicella needs both

Airborne plus contact ≠ Not contact alone

Zoster depends on spread

Localized: standard, cover lesions ≠ Disseminated: airborne plus contact

CLABSI day count

Line >2 calendar days ≠ Insertion day is day 1

Bacteriuria is not CAUTI

Positive culture alone: bacteriuria ≠ CAUTI needs qualifying symptom

IUSS misuse

Not for inventory shortages ≠ Not for routine implants

Chemical indicator is not proof

Color change: exposure only ≠ Biological indicator proves kill

Pass rate is 64%

CBIC reports 64% (2025) ≠ Not the quoted 75%

Alcohol rub is not universal

Spores need soap, water ≠ C. difficile, norovirus: wash

Prevalence moves PPV only

Sensitivity fixed by test ≠ Low prevalence lowers PPV

No going back

Forward only, no flags ≠ Answer before moving on

Last Minute

1. 150 items, 135 scored
2. Two 90-minute sections, forward only
3. Pass = scaled 700 (300-900)
4. Top three domains: 22 items each
5. Standard precautions apply to everyone
6. Airborne = TB, measles, varicella
7. Droplet = flu, pertussis, meningococcus
8. Contact = MDRO, C. difficile
9. Critical sterilize; semicritical high-level
10. Clean before you disinfect
11. BI proves kill; CI proves exposure
12. CLABSI needs line >2 days
13. SIR = observed over predicted
14. Incidence = risk; prevalence = burden
15. 12 ACH: 35 minutes to 99.9%
16. Fit test yearly; seal check daily
17. HBV vaccine within 10 days
18. Retake after 90 days, max four
19. Recert: 40 IPUs or retake
20. New content outline February 2027

CBIC

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