CIC Employee & Occupational Health 4 — Questions and Answers
Question 1: A healthcare worker is found to have a positive IGRA test during annual TB screening. Her previous baseline IGRA was negative. The NEXT step in management is:
- Initiate treatment for latent TB infection immediately without further testing
- Obtain a chest radiograph to rule out active tuberculosis disease (Correct answer)
- Repeat the IGRA in 4 weeks to confirm the result
- Place her on work restriction pending culture results
Correct answer: Obtain a chest radiograph to rule out active tuberculosis disease
A new positive IGRA (conversion) requires a chest X-ray to exclude active TB disease before treating for latent TB infection.
Question 2: Which factor MOST increases the risk of HIV transmission following a percutaneous needlestick injury from an HIV-positive source patient?
- The healthcare worker's ABO blood type
- Deep injury with a hollow-bore needle containing visible blood from a patient with high viral load (Correct answer)
- The type of glove worn at the time of injury
- The anatomical site of the needlestick on the worker
Correct answer: Deep injury with a hollow-bore needle containing visible blood from a patient with high viral load
Deep injuries with hollow-bore needles contaminated with blood from high-viral-load patients carry the greatest transmission risk after percutaneous exposure.
Question 3: Healthcare workers with which condition should generally be excluded from caring for severely immunocompromised patients?
- Remote history of chickenpox with documented immunity
- Active herpes zoster (shingles) with uncovered, weeping lesions (Correct answer)
- Positive IGRA with completed LTBI treatment
- Prior history of hepatitis A with full recovery
Correct answer: Active herpes zoster (shingles) with uncovered, weeping lesions
Active herpes zoster with open lesions poses a transmission risk to immunocompromised patients through direct contact.
Question 4: The MOST effective administrative control for reducing sharps injuries in a healthcare setting is:
- Mandatory double-gloving for all procedures
- Implementing a sharps safety device selection and evaluation program (Correct answer)
- Providing annual needlestick injury training
- Posting sharps precaution reminders at work stations
Correct answer: Implementing a sharps safety device selection and evaluation program
Engineering controls such as safety-engineered sharps devices are more effective than behavioral interventions because they remove or reduce the hazard at the source.
Question 5: Under which circumstance may a healthcare worker with active pulmonary tuberculosis return to work?
- After 2 weeks of effective antituberculosis therapy regardless of sputum results
- After three consecutive negative sputum smears and clinical improvement on effective therapy (Correct answer)
- After completing a full 6-month treatment course
- After a chest X-ray shows resolution of infiltrates
Correct answer: After three consecutive negative sputum smears and clinical improvement on effective therapy
Return-to-work requires clinical improvement, effective therapy, and three consecutive AFB-negative sputum smears to ensure non-infectiousness.
Question 6: An employee health nurse is reviewing vaccination records for new hires. Which vaccine is recommended for all healthcare personnel who lack evidence of immunity, regardless of prior vaccination history?
- Typhoid vaccine
- Varicella vaccine (Correct answer)
- Meningococcal vaccine
- Yellow fever vaccine
Correct answer: Varicella vaccine
ACIP and CDC recommend varicella vaccination for all healthcare personnel without documented immunity, as varicella poses patient and worker risk.
Question 7: A hospital implements a respiratory protection program. Who is responsible for ensuring that the written program is in place, respirators are selected appropriately, and fit testing is conducted?
- The employee using the respirator
- The employer (hospital administration) (Correct answer)
- The unit nurse manager
- The equipment vendor
Correct answer: The employer (hospital administration)
OSHA places the ultimate responsibility for the respiratory protection program — including written plans, proper respirator selection, and fit testing — on the employer.
CIC Employee & Occupational Health 4
A healthcare worker is found to have a positive IGRA test during annual TB screening.
Her previous baseline IGRA was negative.
The NEXT step in management is: