Chapter 3: Infection Control, Safety, First Aid, and Personal Wellness

Which of the following could result in exposure to a bloodborne pathogen by a "percutaneous" exposure route? a. Drawing blood without using a needle safety device b. Handling specimens with ungloved, chapped hands c. Licking your fingers while turning lab manual pages d. Rubbing your eyes while processing blood specimens

Answer: a WHY: "Percutaneous" means through the skin. Percutaneous exposure routes involve direct inoculation of infectious material through previously intact skin, such as routes like accidental needlesticks and injuries from other sharp objects. Drawing blood without using a needle safety device increases the risk of an accidental needlestick. The exposure route involved when handling blood specimens with ungloved, badly chapped hands is nonintact skin contact. Licking your fingers before turning pages of a lab manual could lead to ingestion of infectious material. Rubbing your eyes during specimen-processing activities could lead to mucous membrane contact with infectious material, the permucosal route of exposure.

Which of the following would be considered a healthcare-associated infection? a. Catheter site of an ICU patient becomes infected. b. Child breaks out with measles on admission day. c. Healthcare worker comes down with hepatitis B. d. Patient is admitted with Hantavirus infection.

Answer: a WHY: A healthcare-associated infection (HAI) is an infection that a patient acquires after admission to a healthcare facility. Consequently, a catheter site that becomes infected while a patient is in the intensive care unit (ICU) is a HAI. Because the incubation period for measles is longer than 1 day, the patient with measles acquired the infection before being admitted to the hospital. Infection of a healthcare worker is an occupationally acquired infection, not a HAI. The patient admitted with Hantavirus obviously acquired the virus before admission.

The pathogen responsible for causing an infection is called the infectious a. agent. b. host. c. vector. d. vehicle.

Answer: a WHY: A pathogen is a microbe capable of causing disease. The microbe that is responsible for an infection is referred to as the infectious or causative agent. In human infection transmission, a host is a susceptible individual or one that harbors an infectious agent. A vector is an insect, arthropod, or animal that harbors an infectious agent. A vehicle is food, water, or drugs that are contaminated with the infectious agent.

Which of the following conditions seldom leads to work restrictions for a hospital employee? a. A positive PPD test b. Acute conjunctivitis c. German measles d. Mononucleosis

Answer: a WHY: A positive PPD test means that an individual has been exposed to TB and developed antibodies against it. It does not necessarily mean that the individual has TB. An employee with a positive PPD test would not have restrictions on working if the results of chest x-rays to detect signs of TB were negative. An employee with pink eye (acute conjunctivitis), German measles, or mononucleosis could spread the infection to others and would have work restrictions.

When detected in a patient's serum, the substance abbreviated as HBsAg confirms a. active hepatitis B infection. b. some hepatitis B immunity. c. susceptibility to hepatitis B. d. vaccination for hepatitis B.

Answer: a WHY: Active HBV infection is indicated by the presence of hepatitis B surface antigen (HBsAg) in the patient's serum. HBV immunity and proof of successful vaccination are both indicated by a certain titer (level) of hepatitis B antibody (HBsAb) in the patient's serum. HBV susceptibility is indicated by the absence of hepatitis antibody or an insufficient level of antibody to confer immunity.

Which of the following is proper neonatal ICU blood-drawing procedure? a. Clean hands and put on new gloves for each patient. b. Do not awaken an infant to collect a blood specimen. c. Place the phlebotomy tray right next to the isolette. d. Use povidone-iodine to cleanse skin puncture sites.

Answer: a WHY: Because newborns are more susceptible to infection than older children or adults, strict infection control techniques are required for those working with them. Typical nursery and neonatal ICU infection control techniques include decontaminating hands and putting on new gloves for each patient. Infants must sometimes be awakened to collect specimens. Only the equipment needed is brought into the room, not the phlebotomy tray. Povidone-iodine (e.g., Betadine) should not be used to clean a skin puncture site as it interferes with some tests.

A material or substance harmful to health is the definition of a a. biohazard. b. contaminant. c. pathogen. d. toxic agent.

Answer: a WHY: Biohazard is defined as any material or substance that is harmful to health. Federal regulations require any material that is a biohazard to be marked with a special biohazard symbol (Fig. 3-9).

According to standard first aid procedures, severe external hemorrhage is best controlled by a. applying direct firm pressure to the wound. b. keeping the injured extremity well below heart level. c. placing a tourniquet directly above the affected area. d. raising the victim's head above the level of the injury.

Answer: a WHY: Control of external profuse bleeding (hemorrhage) is most effectively accomplished by applying direct firm pressure to the wound.

Current AHA recommendations for CPR by laypersons emphasize performing a. compressions only. b. eight pulse checks. c. fewer compressions. d. more rescue breaths.

Answer: a WHY: Current American Heart Association (AHA) recommendations simplify CPR for lay rescuers by advocating hands-only (compressions-only) CPR and stressing the need for early chest compressions for victims of cardiac arrest.

Which of the following statements complies with electrical safety guidelines? a. Electrical equipment should be unplugged while being serviced. b. Extension cords should be used to conveniently place equipment. c. It is safe to use a frayed electrical cord if that area has been taped. d. Use electrical equipment carefully if it is starting to malfunction.

Answer: a WHY: Electrical equipment should be unplugged before servicing to avoid electrical shock. The use of extension cords should be avoided because they lead to circuit overload, incomplete connections, and potential clutter in the path of workers. Frayed electrical cords are dangerous and should be replaced rather than used, even if the frayed area has been taped. Malfunctioning equipment should be unplugged and not used until fixed.

Objects that can harbor and transmit infectious material are called a. fomites. b. hosts. c. pathogens. d. vectors.

Answer: a WHY: Fomites are objects capable of adhering to infectious material and transmitting disease. Fomites can include telephones, computer terminals, and countertops. As related to healthcare infection control, hosts harbor infectious agents. A pathogen is a microbe that is capable of causing disease. A vector is an insect arthropod or animal involved in the transmission of an infective microbe.

Hepatitis B vaccination for adults normally involves a. a first shot of vaccine, one a month later, and one 6 months after the first. b. a single shot of vaccine that confers immunity for the individual's lifetime. c. three shots of vaccine each three months apart, then yearly booster shots. d. two shots of vaccine 6 months apart, then a booster shot every 5 years.

Answer: a WHY: Hepatitis B vaccination for adults normally involves three separate injections: an initial dose, another dose 1 month later, and a final dose 6 months from the original dose.

The series of components that lead to infection are referred to as the a. chain of infection. b. immune response. c. infection cycle. d. pathogenic series.

Answer: a WHY: Infection transmission requires the presence of six key components which form the links in what is commonly referred to as the chain of infection (Fig. 3-4). The components are an infectious agent, reservoir, exit pathway, means of transmission, entry pathway, and susceptible host.

The only unsafe laboratory practice of the following list would be to a. keep your lab coat on at all times. b. never eat or apply makeup in the lab. c. secure long hair away from the face. d. wear closed-toe shoes when in the lab.

Answer: a WHY: Laboratory safety procedures include securing long hair away from the face; never eating, drinking, or applying makeup in the laboratory; and wearing closed-toe shoes. A laboratory coat is considered personal protective equipment and as such may become contaminated. It should be worn during procedures that require it, but it should not be worn on break, to lunch, or when leaving the lab to go home.

An example of a disease requiring droplet isolation is a. pertussis. b. rubeola. c. scabies. d. varicella.

Answer: a WHY: Pertussis (whooping cough) is a respiratory disease transmitted by droplets. Varicella (chickenpox) and rubeola are highly contagious and require airborne precautions. Varicella requires contact precautions in addition to airborne precautions. Scabies requires contact precautions.

Which is the correct order for removing protective clothing? a. Gloves, mask, gown b. Gown, gloves, mask c. Gown, mask, gloves d. Mask, gown, gloves

Answer: a WHY: Protective clothing is removed in the opposite order that it is put on. For phlebotomy procedures, the gloves are considered the most contaminated article and are removed first. They are removed by grasping one glove below the wrist and pulling it inside-out off the hand and holding it in the gloved hand. The second glove is removed by slipping several fingers under it at the wrist and pulling it inside-out over the first glove, which ends up inside of it. The mask is removed next, by touching only the strings. The gown is removed last by sliding one's arms out of the sleeves, holding the gown away from the body, and folding it with the outside (contaminated side) in.

Neutropenic isolation is a type of reverse isolation used for patients with a. low WBC counts. b. tuberculosis (TB). c. very severe burns. d. viral meningitis.

Answer: a WHY: Reverse isolation is designed to protect patients who have compromised immune systems. "Neutropenic" is a term used to describe a condition in which there is an abnormally low number of white blood cells (neutrophils). A patient with a low white blood cell count has increased susceptibility to infection and may be placed in a type of protective or reverse isolation called neutropenic isolation. A person with severe burns may be put in reverse isolation because the burns make them susceptible to infection, but this is not called neutropenic isolation.

SDS information includes a. general and emergency information. b. highly technical chemical formulas. c. information on competitor products. d. product manufacturing conditions.

Answer: a WHY: SDS stands for safety data sheet, a document that contains general, precautionary, and emergency information for a product with a hazardous warning on the label. The OSHA Hazard Communication (HazCom) standard (HCS) requires manufacturers to supply safety data sheets for their products. Employers are required to obtain the SDS for every hazardous chemical present in the workplace and have them readily accessible to employees.

The majority of exposures to HIV in healthcare settings are the result of a. accidental needlesticks. b. splashes during surgery. c. tainted blood transfusions. d. touching AIDS patients.

Answer: a WHY: Statistics compiled by the CDC have shown that accidental needlesticks are the leading cause of HIV exposures that have occurred so far among healthcare workers.

Which are the initials of the two organizations responsible for the Guideline for Isolation Precautions in Hospitals? a. CDC and HICPAC b. CLSI and OSHA c. HICPAC and NIOSH d. NIOSH and OSHA

Answer: a WHY: The CDC and HICPAC together developed and jointly issued the Guideline for Isolation Precautions in Hospitals. An update to the guideline identifies two tiers of precautions; standard precautions to be used in the care of all patients, and transmission-based precautions to be used in addition to standard precautions for patients with certain highly transmissible diseases.

Which is the best way to clean up blood that has dripped on the arm of a phlebotomy chair? a. Absorb it with a gauze pad and clean the area with disinfectant. b. Rub it with a damp cloth and wash the area with soap and water. c. Wait for it to dry and then scrape it into a biohazard container. d. Wipe it with an alcohol pad using an outward circular motion.

Answer: a WHY: The best way to clean up small amounts of blood is to absorb them with a paper towel or gauze pad and then clean the area with a disinfectant, being careful not to spread the blood over a wider area than the original spill. Dried spills should be moistened with disinfectant to avoid scraping, which could disperse infectious organisms into the air. They should not be wiped in an outward circular motion as it can spread the contamination. Alcohol is not a disinfectant, nor is soap and water.

Which type of precautions would be used for a patient who has pulmonary tuberculosis? a. Airborne b. Droplet c. Contact d. Reverse

Answer: a WHY: Under transmission-based precautions, airborne isolation is required in addition to standard precautions for a patient who has pulmonary tuberculosis (TB). With airborne precautions, anyone entering the patient's room is required to wear an N95 respirator (Fig. 3-5).

The most frequently occurring laboratory-acquired bloodborne pathogen infection is caused by a. HAV. b. HBV. c. HCV. d. HIV.

Answer: b WHY: According to OSHA, HBV is the most frequently occurring laboratory-acquired bloodborne infection and a major infectious health hazard. Hepatitis A virus (HAV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are also hazards to healthcare workers, but they do not occur as frequently as HBV.

Which of the following patients would require contact precautions pending a diagnosis? a. Child with a maculopapular rash highly suggestive of rubeola (measles) b. Diapered patient with symptoms of infection with an enteric pathogen c. HIV-positive patient who has a cough, fever, and pulmonary infiltrate d. Man with a severe persistent cough indicative of Bordetella pertussis

Answer: b WHY: According to transmission-based precautions, symptoms of infection with an enteric pathogen in an incontinent or diapered patient warrant contact precautions pending diagnosis. A child with a rash suggestive of rubeola requires airborne precautions. A cough, fever, and pulmonary infiltrate in an HIV patient are suggestive of TB infection and require airborne precautions. A cough indicative of Bordetella pertussis requires droplet precautions.

The purpose of reverse isolation is to a. prevent airborne transmission of infectious microbes. b. protect susceptible patients from outside contamination. c. provide the safest environment for psychiatric patients. d. separate contagious patients from contact with others.

Answer: b WHY: Also called "protective" isolation, reverse isolation is a special kind of isolation that is used for patients who are highly susceptible to infections. Examples of patients requiring protective isolation are patients with compromised immune systems such as neutropenic patients (those with abnormally low white blood cell counts), severely burned patients, and patients with compromised immune systems such as AIDS patients.

Which would contribute to the chain of infection rather than help break it? a. Implementing isolation procedures b. Opening exit pathways for pathogens c. Practicing stress reduction techniques d. Washing hands and wearing gloves

Answer: b WHY: An exit pathway is the way an infectious agent is able to leave a reservoir host and be transmitted to a new susceptible individual and should be blocked, not opened. Infectious agents can exit a reservoir host in secretions from the eyes, nose, or mouth; exudates from wounds; tissue specimens; blood from venipuncture and skin puncture sites; and excretions of feces and urine. Blocking a pathogen exit pathway by protecting oneself from secretions, excretions, exudates, and other potentially infectious body substances can break the chain of infection. Implementing isolation procedures, practicing stress reduction, washing hands, and wearing gloves all help break the chain of infection.

Which of the following actions violates a chemical safety rule? a. Adding acid to water when diluting an acid b. Adding bleach to a cleaner to make it more effective c. Making a 1:10 dilution of bleach to clean a counter d. All of the above

Answer: b WHY: Bleach or bleach solutions should never be mixed with other cleaners because doing so can release dangerous gases.

The main principles involved in radiation exposure are a. exposure rate, dose, and shelter. b. distance, shielding, and time. c. source, amount, and duration. d. strength, location, and protection.

Answer: b WHY: Distance, shielding, and time are the principles involved in radiation exposure. This means that the amount of radiation you are exposed to depends on how far you are from the source of radioactivity, what protection you have from it, and how long you are exposed to it.

Class C fires involve a. combustible metals. b. electrical equipment. c. flammable liquids. d. ordinary materials.

Answer: b WHY: Fires are classified by fuel source. Class C fires occur with electrical equipment. Class A fires involve ordinary combustible materials, Class B fires involve flammable liquids, and Class D fires involve combustible metals. Class K fires involve cooking oils, fat, or grease.

The first three components of fire that were traditionally referred to as the fire triangle are a. carbon, air, and static. b. fuel, oxygen, and heat. c. oxygen, energy, and fuel. d. vapor, heat, and static.

Answer: b WHY: Four components must be present for fire to occur. Three of them are the traditional fire triangle components of fuel (material that will burn); heat (to raise the temperature of the material to a point where it will ignite); and oxygen (to maintain combustion). The fourth component is the chemical reaction that produces the fire. Addition of the fourth component to the original fire triangle created the fire tetrahedron (Fig. 3-6).

The fourth component that turns the fire triangle into a fire tetrahedron is a a. chain of ignition. b. chemical reaction. c. combustible item. d. temperature boost.

Answer: b WHY: Fuel, oxygen, and heat make up the traditional fire triangle. Adding the fourth component, the chemical reaction that produces fire, creates a fire tetrahedron (see Fig. 3-6), which is the latest way of looking at the chemistry of fire.

A person's general susceptibility to infection is unaffected by a. age. b. gender. c. health. d. immunity.

Answer: b WHY: Gender does not play a role in a person's general susceptibility to infection. Age, health, and immune status do. Gender may, however, play a role in the site of infection because of differences in male and female anatomy.

What is the first thing a phlebotomist should do if he or she is accidentally stuck by a needle used to draw blood from a patient? a. Check the patient's medical records for HIV test results b. Clean the site with soap and water for at least 30 seconds c. Go to employee health services and get a tetanus booster d. Leave the area so the patient does not notice the injury

Answer: b WHY: If an accidental needlestick occurs, it is very important to decontaminate the site immediately. The exposure should then be reported to the supervisor and an incident report filled out. The phlebotomist should also report to the employee health department for medical evaluation and possible treatment. Checking the patient's medical record cannot be done as it would violate HIPAA confidentiality regulations.

A person who has recovered from a virus and has developed antibodies against that virus is said to be a. a carrier. b. immune. c. infectious. d. susceptible.

Answer: b WHY: Immunity to a specific virus normally exists when a person's blood has antibodies directed against that virus. A person who has recovered from infection with a virus has antibodies directed against it and is considered immune. Such a person would no longer be infectious, or able to transmit the virus to others. A person who does not display symptoms of a virus such as hepatitis B but whose blood contains the virus can transmit it to others and is called a carrier. A person who is susceptible to a virus has no antibodies against it.

An individual who has little resistance to an infectious microbe is referred to as a susceptible a. agent. b. host. c. pathway. d. reservoir.

Answer: b WHY: In healthcare, a susceptible host is someone with decreased ability to resist infection. A microbe responsible for an infection is called the causative or infectious agent. An exit or entry pathway is the way an infectious microbe is able to leave or to enter a host, respectively. A reservoir is a place where an infectious microbe can survive and multiply and includes humans, animals, food, water, soil, contaminated articles, and equipment.

The blue quadrant of the NFPA diamond-shaped symbol for hazardous materials (see Fig. 3-1) indicates a a. fire hazard. b. health hazard. c. reactivity hazard. d. specific hazard.

Answer: b WHY: In the NFPA hazardous materials rating system (see Fig. 3-8), health hazards are indicated in the blue quadrant on the left. The upper red quadrant indicates fire hazards. Stability or reactivity hazards are indicated in the yellow quadrant on the right, and other specific hazards are indicated in the white quadrant on the bottom.

Isolation procedures are used to separate patients from contact with others if they a. are carriers of a bloodborne pathogen. b. have highly transmissible infections. c. require blood or body fluid precautions. d. were exposed to a contagious disease.

Answer: b WHY: Isolation procedures minimize the spread of infection by separating patients with highly transmissible infections from contact with other patients, and limiting their contact with hospital personnel and visitors. Simply being a carrier of a bloodborne pathogen or having been exposed to a contagious disease does not warrant isolation procedures. Standard precautions, which encompass blood and body fluid precautions, are used in the care of all patients.

All pathogens are a. communicable microorganisms. b. microbes that can cause disease. c. microorganisms that live in soil. d. normal flora found on the skin.

Answer: b WHY: Microorganisms (microbes) that can cause disease are called pathogens. Communicable microorganisms are pathogens that can be spread from person to person. Only some pathogenic microbes live in the soil. Normal flora (microorganisms that live on the skin) do not cause disease under normal conditions.

Which are the initials of the organization that instituted universal precautions, the precursor to standard precautions? a. CAP b. CDC c. NIOSH d. OSHA

Answer: b WHY: The CDC introduced the concept of universal precautions (UP) because it is not always possible to know if a patient is infected with a bloodborne pathogen. Under UP, blood and certain body fluids of all patients are considered potentially infectious.

Which are the initials of the agency that developed a hazard labeling system that is a diamond-shaped sign containing a United Nations hazard class number and a symbol representing the hazard? a. CDC b. DOT c. NFPA d. OSHA

Answer: b WHY: The Department of Transportation (DOT) labeling system (Fig. 3-10) uses a diamond-shaped warning sign incorporating a United Nations hazard class number and symbol as well as a four-digit identification number. This symbol should not be confused with the NFPA diamond-shaped sign divided into four quadrants used to signify specific hazards.

The primary purpose of wearing gloves during phlebotomy procedures is to protect the a. patient from contamination by the phlebotomist. b. phlebotomist from exposure to the patient's blood. c. specimen from contamination by the phlebotomist. d. venipuncture site from contamination by the hands.

Answer: b WHY: The OSHA Bloodborne Pathogens (BBP) standard requires glove use during phlebotomy procedures to protect the phlebotomist from bloodborne pathogen contamination. Gloves do not necessarily protect the patient; in fact, they can be a source of contamination to the patient if the phlebotomist touches contaminated articles before touching the patient's arm. Gloves can also be a source of contamination to capillary puncture specimens. Rather than protecting the venipuncture site, gloves can contaminate it if the phlebotomist touches the site after it is cleaned.

What does the NFPA acronym "RACE" mean? a. React, activate, cover, extinguish b. Rescue, alarm, confine, extinguish c. Respond, activate, confine, escape d. Run, alarm, counter, extinguish

Answer: b WHY: The acronym "RACE" was established by the National Fire Protection Association (NFPA) as a way to remember the order of action steps in the event of a fire. The R stands for rescue individuals in danger (step 1). The A stands for sound the alarm (step 2). The C stands for confine the fire by closing doors and windows (step 3). The E stands for extinguish the fire with the nearest fire extinguisher (step 4).

You accidentally splash a bleach solution in your eyes while preparing it for cleaning purposes. What is the first thing to do? a. Dry your eyes quickly with a clean paper towel or tissue. b. Flush your eyes with water for a minimum of 15 minutes. c. Proceed to the emergency room as quickly as possible. d. Put 10 to 20 drops of saline in your eyes immediately.

Answer: b WHY: The immediate thing to do in the event of a chemical splash to the eyes is to flush them with water for a minimum of 15 minutes at the nearest eyewash station. Figure 3-7 Eyewash station. A. Press the lever at the right side of the basin. B. The stream of water forces the caps from the nozzles. Lower your face and eyes into the stream and continue to wash the eye area until your eyes are clear.

Which one of the following diseases involves a bloodborne pathogen? a. Diphtheria b. Hepatitis B c. Meningitis d. Pneumonia

Answer: b WHY: The microbe that causes hepatitis B is a bloodborne pathogen. Diphtheria meningitis and pneumonia are not transmitted through the blood.

Which precautions are to be used for a patient who has an enteric pathogen? a. Airborne b. Contact c. Droplet d. Standard

Answer: b WHY: The word "enteric" is defined as pertaining to the small intestine. The route of exposure for enteric pathogens is ingestion. According to guidelines for transmission-based precautions, contact precautions should be followed in addition to standard precautions for patients with enteric pathogens.

Transmission-based precautions must be followed for patients with a. compromised immune systems. b. highly transmissible diseases. c. severe gastrointestinal distress. d. symptoms of acute appendicitis.

Answer: b WHY: Transmission-based precautions are used in addition to standard precautions only for patients who are known or suspected to be infected or colonized with highly transmissible or epidemiologically significant pathogens.

Which of the following diseases involves a bloodborne pathogen? a. Diphtheria b. Influenza c. Malaria d. Rubella

Answer: c WHY: "Bloodborne pathogen" is a term applied to any infectious microorganism present in blood and other body fluids and tissues. It most commonly refers to HBV and HIV but also includes the organisms that cause syphilis, malaria, relapsing fever, and Creutzfeldt-Jakob disease. The microorganisms that cause diphtheria, influenza, and rubella are not found in the blood.

Which type of precautions are required for a patient with mycoplasma pneumonia? a. Airborne b. Contact c. Droplet d. Standard

Answer: c WHY: A patient with mycoplasma pneumonia requires droplet precautions, one of three types of transmission-based precautions used for patients known or suspected to be colonized or infected with certain highly transmissible pathogens. Droplet precautions protect against microbes transmitted in droplets generated when a person talks, coughs, or sneezes, and during certain procedures such as suctioning. The other two transmission-based precautions are airborne and contact. Airborne precautions protect against microbes transmitted in droplet nuclei, which are the residue of evaporated droplets. Contact precautions protect against microbes transmitted by contact with a patient, or contaminated items and surfaces. Transmission-based precautions are used in addition to the standard precautions, which are used in the care of all patients.

A radiation hazard symbol (Fig. 3-2) on a patient's door signifies a patient who a. has been sent to the radiology department. b. has had x-rays taken in the past few days. c. is being treated with radioactive isotopes. d. is scheduled for a radiology procedure.

Answer: c WHY: A radiation hazard sign (see Fig. 3-2) on a patient's door means the patient has been injected with radioactive dyes or has radioactive implants. Although they are inside the patient, these radioactive isotopes can be hazardous to the fetus of a pregnant healthcare worker. In addition, a blood specimen collected at this time may be radioactive.

According to the CDC prevalence survey, how many hospital patients have at least one HAI on any given day? a. One out of five b. One out of 10 c. One out of 25 d. One out of 50

Answer: c WHY: According to the CDC, the most recent HAI progress report found that on any given day about 1 in 25 patients has at least one HAI.

An avulsion is a a. hematoma in an extremity. b. situation that is repulsive. c. tearing away of a body part. d. type of operation on a bone.

Answer: c WHY: An avulsion is the forceful tearing away or amputation of a body part.

The main purpose of a hospital infection control program is to a. identify the source of communicable infections. b. separate infectious patients from other patients. c. prevent the spread of infection in the hospital. d. protect patients from outside contamination.

Answer: c WHY: An infection control program is responsible for implementing procedures designed to break the chain of infection and prevent the spread of infection in the hospital.

Which of the following makes a patient less susceptible to infection with a specific microbe? a. Antibiotic treatment b. Chemotherapy drugs c. Previous vaccination d. Surgical procedures

Answer: c WHY: Antibiotic treatment, chemotherapy drugs, and surgical procedures can all increase a patient's susceptibility to infection. Vaccination against a specific microbe decreases the likelihood of infection (i.e., makes them less susceptible to infection) with that microbe. Previous vaccination does not decrease an individual's present susceptibility to other types of infection.

The free availability of personal protective equipment (PPE) for employee use in the medical laboratory is mandated by the a. Clinical Laboratory Improvement Amendments. b. Guideline for Isolation Precautions in Hospitals. c. OSHA Bloodborne Pathogens (BBP) standard. d. OSHA Hazard Communication (HazCom) standard.

Answer: c WHY: Availability of PPE for use in the laboratory is mandated by the BBP standard to minimize occupational exposure to HBV, HIV, and other bloodborne pathogens. The Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) are concerned with laboratory testing. The CDC and HICPAC Guideline for Isolation Precautions in Hospitals describes what PPE to use for the different categories of precautions but has no authority to regulate availability of PPE. The OSHA HazCom standard deals with communicating chemical hazards to employees.

The best course of action to take before entering an isolation room is a. ask the patient's nurse what to do. b. do whatever you did the last time. c. follow the posted precautions. d. put on gloves and a respirator.

Answer: c WHY: Because different types of isolation require the use of different types of personal protective equipment, the best thing to do before entering an isolation room is to follow the directions on the precaution sign on the door. Precautions needed are usually indicated on the sign, or you may be directed to check with the patient's nurse before entering the room. You must check the sign even if you have entered that room before, as precautions may have changed.

What is the meaning of the symbol "W" in Figure 3-1? a. Water-based b. Water-neutral c. Water-reactive d. Water-soluble

Answer: c WHY: Figure 3-1 represents the National Fire Protection Association (NFPA) 704 marking system used to identify areas where hazardous chemicals are present. The symbol means "water-reactive" and identifies material that should not come in contact with water (Fig. 3-8).

The body organ targeted by HBV is the a. brain. b. heart. c. liver. d. lungs.

Answer: c WHY: Hepatitis means inflammation of the liver. (The word root "hepat" means liver, and the suffix "itis" means inflammation.) Hepatitis B virus (HBV) and the other hepatitis viruses target the liver, causing liver inflammation.

A laboratory or patient care activity that requires goggles to prevent exposure from sprays or splashes also requires which protective attire? a. Earplugs b. Gown c. Mask d. Respirator

Answer: c WHY: If a laboratory or patient care activity requires a healthcare worker to wear goggles to prevent exposure from sprays or splashes, a mask must also be worn to prevent mucous membrane exposure of the nose and mouth.

Healthcare workers are considered immune to a disease if they a. eat right and get enough rest and exercise. b. have a normal number of white blood cells. c. have contracted the disease and recovered. d. received gamma globulin in the past year.

Answer: c WHY: Immunity to a specific disease is conferred by having had the disease and therefore developing antibodies against the disease-causing organism, or by vaccination against the organism. Eating right, getting enough rest, and exercising are all important in staying healthy and reducing susceptibility to disease, but they will not make an individual immune to a disease. A normal white blood cell count is necessary to fight infection, but it is not an indication of immunity. A shot of gamma globulin or immune globulin confers temporary immunity.

Which of the following are something other than microbes? a. Bacteria b. Fungi c. Ova d. Viruses

Answer: c WHY: Microbes (a short term for microorganisms) are tiny life forms that cannot be seen with the naked eye. They include bacteria, fungi, protozoa, and viruses. Ova (gametes or eggs) are reproductive cells, and although they may be microscopic they are not microorganisms.

A patient might be placed in protective isolation if he or she has a. chickenpox. b. hepatitis C. c. severe burns. d. tuberculosis.

Answer: c WHY: Protective or reverse isolation is used for patients who are highly susceptible to infections as in the case of a severely burned patient. Hepatitis C requires standard precautions. Chickenpox and tuberculosis require airborne precautions in addition to standard precautions.

An example of employee screening for infection control is requiring employees to have a. hepatitis B vaccinations. b. measles vaccinations. c. PPD (or TB) testing. d. tetanus booster shots.

Answer: c WHY: Purified protein derivative (PPD) is the antigen used in a tuberculosis (TB) test. Both PPD and TB are abbreviations used for the test, which screens for exposure to tuberculosis. Hepatitis B vaccination, measles vaccinations, and tetanus booster shots are examples of employee immunizations that prevent the spread of infection.

Which body fluid is exempt from standard precautions? a. Joint fluid b. Saliva c. Sweat d. Urine

Answer: c WHY: Standard precautions apply to all body fluids, excretions, and secretions except sweat, whether or not they contain visible blood.

The "right to know" law primarily deals with a. electrical safety issues. b. exposure to pathogens. c. hazard communication. d. labeling of specimens

Answer: c WHY: The OSHA HazCom standard, which is called the "right to know" law, requires manufacturers of hazardous materials to provide an SDS for every hazardous product they make. An SDS contains general, precautionary, and emergency information about the product.

The HazCom standard is also commonly called the a. full disclosure law. b. material safety law. c. right to know law. d. universal safety law.

Answer: c WHY: The OSHA Hazardous Communication standard (HCS), which is also called the HazCom standard, is known as the "right to know" law because it requires all chemicals to be evaluated for health hazards, all chemicals found to be hazardous to be labeled as such, and the information communicated to employees. Recent changes to the standard now also give employees the ability to understand the chemical hazards they may face.

The ability of a microorganism to survive on contaminated articles and equipment has to do with its a. susceptibility. b. transmission. c. viability. d. virulence.

Answer: c WHY: The ability of a microorganism to survive on contaminated articles and equipment has to do with its viability, which is the ability to survive.

Which mode of infection transmission occurs from touching contaminated bed linens? a. Direct contact b. Droplet contact c. Indirect contact d. Vehicle contact

Answer: c WHY: The indirect contact mode of infection transmission occurs when a susceptible individual touches contaminated inanimate objects such as bed linens. Direct contact transmission involves direct, physical transfer of an infective microbe through close or intimate contact such as touching or kissing. Droplet transmission involves the transfer of an infective microbe to the mucous membranes of a susceptible individual through sneezing, coughing, or talking. Vehicle transmission involves contaminated food, water, drugs, or blood for transfusion.

What does the following GHS hazard symbol represent? a. Acute toxicity b. Cardiac hazard c. Health hazard d. Narcotic effects

Answer: c WHY: The pictogram identifies a health hazard. It is one of the nine GHS universal pictograms incorporated into the OSHA Hazardous Communication standard (HCS).

When the chain of infection is broken, an a. individual is immune to that microbe. b. individual is susceptible to infection. c. infection is prevented from happening. d. infection will most likely be the result.

Answer: c WHY: The process of infection requires the chain of infection (see Fig. 3-4) to be complete. Stopping or interrupting the process by such things as wearing gloves, immunization of susceptible individuals, or instituting isolation procedures, breaks the chain and prevents infection.

The term pathogenic means a. highly communicable. b. possessing virulence. c. productive of disease. d. systemic in nature.

Answer: c WHY: The term "pathogenic" means causing or productive of disease. A microorganism that is capable of causing disease is said to be pathogenic. Communicable is an adjective used to describe infections that can spread from person to person. Virulence is the degree to which an organism is capable of causing disease. Systemic means pertaining to the entire body.

All the following are required parts of an exposure control plan EXCEPT a. an exposure determination. b. communication of hazards. c. isolation procedure policies. d. methods of implementation.

Answer: c WHY: To comply with OSHA standards, an exposure control plan must contain an exposure determination, communication of hazards, and methods of implementation. Isolation procedure policies are not a required part of an exposure control plan.

An example of vector infection transmission is contracting a. HBV from a contaminated countertop. b. HIV from a tainted blood transfusion. c. the plague from the bite of a rodent flea. d. tuberculosis after inhaling droplet nuclei.

Answer: c WHY: Vector transmission involves transfer of the microbe by an insect, arthropod, or animal, for example, the bite of a rodent flea. HIV acquired from a blood transfusion is vehicle transmission. Contracting hepatitis B infection from a contaminated countertop is indirect contact transmission involving a fomite. Contracting tuberculosis from droplet nuclei is airborne transmission.

Which is the proper order for putting on protective clothing? a. Gloves, gown, mask b. Gown, gloves, mask c. Gown, mask, gloves d. Mask, gown, gloves

Answer: c WHY: When putting on protective clothing, the healthcare worker puts on the gown first, being careful to touch only the inside surface. The mask is put on next. Gloves are applied last and pulled over the cuffs of the gown.

The term used to describe an infection that infects the entire body is a. communicable. b. local. c. nosocomial. d. systemic.

Answer: d WHY: "Systemic" means pertaining to a whole body rather than one of its parts. A systemic infection infects the entire body. A communicable infection is one that is spread from person to person. A local infection is restricted to a small area of the body. A nosocomial infection is a hospital-acquired infection.

Which of the following statements concerning an employee bloodborne pathogen exposure incident is true? a. Exposures need not be documented if no transmission occurs. b. Incidents must be promptly reported to the CDC and OSHA. c. Source patients, if known, must be tested for HIV and HBV. d. The employee is entitled to a confidential medical evaluation.

Answer: d WHY: According to the BBP standard, employees are entitled to a confidential medical evaluation. Exposures must be documented whether or not transmission of an infectious agent occurs. OSHA requires the facility to keep a log of exposure incidents, but they do not have to be reported independently to the CDC or OSHA. It is not mandatory for the source patient to submit to HIV or HBV testing. The source patient will be asked to submit to testing, and it is hoped that he or she will do so.

Which of the following is part of proper handwashing procedure? a. Apply a generous amount of soap to dry hands. b. Stand as close to the water source as possible. c. Use one towel to dry hands and turn off faucets. d. Wash hands thoroughly for at least 20 seconds.

Answer: d WHY: According to the CDC, proper handwashing procedure requires hands to be washed thoroughly for at least 20 seconds. Hands should be wet before applying soap to minimize drying, chapping, and cracking. One should stand back from the sink to prevent touching it since it may be contaminated. A clean paper towel should be used to turn off the faucet after handwashing. Using the same paper towel to dry the hands and turn off the faucets can contaminate the faucet handles and the hands.

Which of the following is required by the Bloodborne Pathogens (BBP) standard? a. Isolation of patients known to be HIV-positive b. Gowning before entering rooms of AIDS patients c. Warning labels on specimens from AIDS patients d. Wearing gloves when performing phlebotomy

Answer: d WHY: According to the OSHA Bloodborne Pathogens standard, gloves are to be worn when performing vascular access procedures. This means that gloves are required for phlebotomy procedures. HIV-positive patients are not normally isolated unless they have AIDS and their immune systems are severely weakened, in which case they may be placed in protective isolation. A gown may be required in certain situations but is not normally required when working with AIDS patients. It is against the law to label specimens from patients with bloodborne pathogens any differently than other specimens.

Which equipment is required when collecting a specimen from a patient in airborne isolation? a. Eye protection b. Full face shield c. Mask and goggles d. N95 respirator

Answer: d WHY: Anyone entering the room of a patient with airborne precautions must wear an N95 respirator (see Fig. 3-5) unless the precautions are for rubeola or varicella and the individual entering the room is immune.

Which class of fire occurs with combustible metals? a. Class A b. Class B c. Class C d. Class D

Answer: d WHY: Class D fires occur with combustible or reactive metals such as sodium, potassium, magnesium, and lithium. Class A fires occur with ordinary combustible materials. Class B fires occur with flammable liquids, and Class C fires occur with electrical equipment.

Which of the following symptoms of shock is wrong? a. An expressionless face b. Increased shallow breathing c. Pale, cold, clammy skin d. Slow, strong, pulse rate

Answer: d WHY: Common symptoms of shock are an expressionless face and staring eyes; increased shallow breathing; pale, cold, and clammy skin; and a rapid, weak pulse rather than a slow, strong pulse.

Exercise reduces stress by a. decreasing buildup of lactic acid. b. increasing utilization of glucose. c. promoting glycogen production. d. triggering release of endorphins.

Answer: d WHY: Exercise reduces stress by triggering the release of substances called endorphins, which create an exhilarating yet peaceful state.

Which of the following is considered one of the most important means of preventing healthcare-associated infections? a. Current immunization b. Glove use if indicated c. Isolation procedures d. Proper hand hygiene

Answer: d WHY: Healthcare-associated infections can result from contact with infected personnel, other patients, visitors, or equipment. Studies have shown that the best way to prevent transmission of pathogenic microorganisms is proper hand hygiene, which includes the frequent use of antiseptic hand cleaners or handwashing, depending upon the degree of contamination. Following isolation procedures and being up-to-date on immunizations are important in preventing specific infections. Wearing gloves when required plays a role in infection control, but proper hand hygiene measures are still required after glove removal.

The abbreviation for the virus that causes acquired immune deficiency syndrome (AIDS) is a. HAV. b. HBV. c. HCV. d. HIV.

Answer: d WHY: Human immunodeficiency virus (HIV) is the leading cause of AIDS. Hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV) cause hepatitis A, hepatitis B, and hepatitis C, respectively.

Which are the initials of the federal agency that instituted and enforces regulations requiring the labeling of hazardous materials? a. CDC b. EPA c. NFPA d. OSHA

Answer: d WHY: OSHA instituted and enforces the Hazard Communication (HazCom) standard (HCS). This federal law requires the labeling of hazardous materials. The HCS has been revised to align with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS) that is being promoted for use worldwide.

Federal law requires that hepatitis B vaccination be made available to employees assigned to duties with occupational exposure risk a. after any probationary period is over. b. immediately or as soon as possible. c. within one month of their employment. d. within 10 working days of an assignment.

Answer: d WHY: OSHA regulations require employers to offer HBV vaccination free of charge to employees within 10 days of their assignment to duties with risk of exposure.

Which are the initials of the United States government agency that mandates and enforces safe working conditions for employees? a. CDC b. HICPAC c. NIOSH d. OSHA

Answer: d WHY: OSHA stands for the Occupational Safety and Health Administration. This agency enforces the Occupational Safety and Health Act (also OSHA), a federal law that requires employers to ensure safe working conditions. The Centers for Disease Control and Prevention (CDC) is charged with the investigation and control of certain communicable diseases with epidemic potential. The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal committee of experts who provide advice and guidance to the CDC and the Department of Health and Human Services (HHS) regarding infection control. The National Institute for Occupational Safety and Health (NIOSH), a federal agency that is part of the CDC, is responsible for conducting research and making recommendations for the prevention of work-related injury and illness.

A specimen processor removes the stopper from a tube without barrier protection and feels a mist of specimen touch the eyes. Which type of exposure occurs through eye contact? a. Airborne b. Nonintact skin c. Percutaneous d. Permucosal

Answer: d WHY: Permucosal means through or across mucous membranes, moist tissue layers that line areas of the body open to the environment such as eyes, nose, and mouth. Mucous membranes can be an entry pathway for infectious agents if aerosols or splashes land on them. Airborne exposure occurs if an infectious agent is inhaled. Nonintact skin exposure occurs through visible or invisible pre-existing breaks in the skin. Percutaneous exposure occurs when a sharp object penetrates previously intact skin.

Standard precautions should be followed a. for anyone with hepatitis B. b. if a patient is HIV-positive. c. while a patient is in isolation. d. with all patients at all times.

Answer: d WHY: Standard precautions should be followed for all patients at all times with no exceptions. When standard precautions are followed, it is not necessary to know if the patient has hepatitis B or is HIV-positive. Patients in normal isolation require transmission-based precautions in addition to standard precautions. Reverse isolation requires precautions to protect the patient in addition to standard precautions.

Which are the initials of the organization that instituted and enforces the Bloodborne Pathogens standard? a. CAP b. CDC c. NIOSH d. OSHA

Answer: d WHY: The BBP standard was instituted by OSHA when it was determined that healthcare employees face a serious health risk as a result of occupational exposure to bloodborne pathogens. The standard is part of federal law, and OSHA is responsible for its enforcement.

Which is the best way to extinguish a flammable liquid fire? a. Dousing it with large amounts of water b. Smothering it with a special fire blanket c. Spraying it with a Class A extinguisher d. Spraying it with a Class B extinguisher

Answer: d WHY: The Class B fire extinguisher was designed to put out flammable liquid fires which require blocking the source of oxygen or smothering the fuel to extinguish the fire. Class B extinguishers use foam, dry chemicals, or carbon dioxide to smother the fire. Pouring water on it can disperse the flammable liquid and spread the fire. Fire blankets are used to smother clothing fires. Class A extinguishers could also spread the fire, especially if they contain water.

The focus of infection control turned from preventing patient-to-patient transmission to preventing patient-to-personnel transmission with the introduction of which concept? a. Body substance isolation (BSI) b. Category-specific isolation c. Disease-specific isolation d. Universal precautions (UP)

Answer: d WHY: The concept that the blood and certain body fluids of all patients potentially contain bloodborne pathogens originated with the introduction of universal precautions (UP) by the CDC. This concept changed the focus of infection control from prevention of patient-to-patient transmission to prevention of patient-to-personnel transmission. Category-specific and disease-specific precautions focused on patient-to-patient transmission. BSI focused on patient-to-personnel transmission, but came after UP.

The most common type of HAI in the United States is a. bedsore infection. b. hepatitis B infection. c. respiratory infection. d. urinary tract infection.

Answer: d WHY: The most widely used HAI tracking system is provided by the CDC National Healthcare Safety Network (NHSN). Data provided by NHSN helps United States healthcare facilities eliminate HAIs by identifying problem areas and measuring progress of prevention efforts. The most common type of HAI reported to the HSN is urinary tract infection (UTI), accounting for over 30% of all HAIs.

The degree to which a microorganism is capable of causing disease is the definition of a. resistance. b. susceptibility. c. viability. d. virulence.

Answer: d WHY: The virulence of a microorganism is the degree to which it is capable of causing disease. Resistance and susceptibility have to do with the immune system of the host and are affected by such things as age and health. Viability is the ability of the microorganism to survive on a source.

Which of the following is an example of possible parenteral means of transmission? a. Drinking water from a glass that is contaminated. b. Licking your fingers as you turn pages of a book. c. Not washing your hands before eating your lunch. d. Rubbing your eyes without washing hands first.

Answer: d WHY: The word "parenteral" means other than the digestive tract. Drinking water, ingesting contaminates by licking fingers, or failing to wash hands before eating food all involve the digestive tract and therefore are not parenteral. Rubbing your eyes without washing hands first does not involve the digestive tract and is therefore a possible parenteral means of transmission.

How many classes of fire are identified by the National Fire Protection Association (NFPA)? a. Two b. Three c. Four d. Five

Answer: d WHY: There are five classes of fire recognized by the NFPA. Fires are classified by fuel source. Class A fires involve ordinary combustible materials. Class B fires involve flammable liquids. Class C fires occur with electrical equipment. Class D fires involve combustible metals. Class K fires (the newest class) occur with cooking oils, grease, or fat.

What should the phlebotomist do if the outside of a patient specimen tube has blood on it? a. Discard it and draw a new tube b. Label it with a biohazard sticker c. Put the specimen in a new tube d. Wipe the tube with disinfectant

Answer: d WHY: To prevent contamination of other workers who may handle it, a tube that has blood on it should be wiped with disinfectant.

In which instance could an electrical shock to a patient most likely occur? a. Collecting a blood specimen during a bad electrical storm b. Performing phlebotomy while the patient is on the phone c. Standing on a wet floor while drawing a blood specimen d. Touching some electrical equipment during a blood draw

Answer: d WHY: Touching electrical equipment while drawing a patient's blood could conceivably cause a short to travel through the needle and shock the patient. Drawing a patient's blood when he or she is talking on the phone, during an electrical storm, or while you are standing on a wet floor will not cause electrical shock to the patient.

An individual is infected with E. coli after eating contaminated spinach. Which type of infection transmission is involved? a. Contact b. Droplet c. Vector d. Vehicle

Answer: d WHY: Transmission of an infective agent through contaminated food, water, or drugs is called vehicle transmission. Contact transmission involves direct transmission of an infectious microbe to a susceptible host through close or intimate contact such as kissing, or indirect transmission of the microbe by personal contact with a contaminated inanimate object. Droplet transmission involves the transfer of the microbe to the mucous membranes of a susceptible host by activities such as sneezing, coughing, or talking by an infected person. Vector transmission typically involves the transfer of the microbe by an insect, arthropod, or animal.

Which of the following diseases or microbes can be transmitted through blood transfusion? a. Bubonic plague b. Diabetes mellitus c. Clostridium difficile d. Treponema pallidum

Answer: d WHY: Treponema pallidum, the organism that causes syphilis, is a bloodborne pathogen that can be transmitted through blood transfusion if present in the transfused blood. Bubonic plague is a vector-borne disease caused by Yersinia pestis. Diabetes mellitus is an endocrine disorder involving improper carbohydrate metabolism. Clostridium difficile is an enteric pathogen.

Which of the following is an example of a work practice control that reduces risk of exposure to bloodborne pathogens? a. Ordering self-sheathing needles b. Reading the exposure control plan c. Receiving an HBV vaccination d. Using safety needles to draw blood

Answer: d WHY: Work practice controls are routines that alter the manner in which a task is performed to reduce likelihood of exposure to bloodborne pathogens (BBPs). Using safety needles to draw blood reduces the chance of exposure to BBPs. Ordering self-sheathing needles, reading the exposure control plan, and receiving an HBV vaccination are all important in reducing the risk of exposure to BBPs but do not in themselves alter the actual performance of a task and are not considered work practice controls.