FACEM Safety and Infection Control 2 — Questions and Answers
Question 1: A patient with suspected Ebola virus disease arrives in the ED. Which PPE ensemble is required for healthcare workers performing direct patient care?
- Surgical mask, gloves, and gown
- N95 respirator, face shield, double gloves, gown, and boot covers (Correct answer)
- Full encapsulating suit with SCBA only
- Standard contact precautions with a surgical mask
Correct answer: N95 respirator, face shield, double gloves, gown, and boot covers
Ebola requires enhanced contact/droplet precautions including N95 or PAPR, face shield, double gloves, impermeable gown, and boot covers to prevent exposure to infectious body fluids.
Question 2: Which strategy best reduces the risk of needlestick injuries during IV cannulation in the emergency department?
- Recapping needles using the two-handed technique
- Using safety-engineered devices with passive activation (Correct answer)
- Wearing double gloves during all procedures
- Disposing of needles in a sharps container immediately after use
Correct answer: Using safety-engineered devices with passive activation
Safety-engineered devices with passive (automatic) activation features provide the greatest reduction in needlestick injuries by activating without additional steps from the user.
Question 3: A nurse sustains a needlestick from a patient with unknown HIV status. What is the recommended window for initiating post-exposure prophylaxis (PEP)?
- Within 1 hour
- Within 72 hours (Correct answer)
- Within 1 week
- Within 2 weeks
Correct answer: Within 72 hours
HIV PEP should be initiated as soon as possible but remains effective if started within 72 hours of exposure; earlier initiation improves efficacy.
Question 4: What is the most appropriate action when a patient with confirmed pulmonary tuberculosis requires emergent intubation?
- Perform rapid sequence intubation in a standard resuscitation bay
- Transfer the patient to a negative-pressure room before intubation if at all possible (Correct answer)
- Use only bag-valve-mask ventilation to avoid aerosol generation
- Defer intubation until TB treatment has been initiated for 2 weeks
Correct answer: Transfer the patient to a negative-pressure room before intubation if at all possible
Intubation of a TB patient should occur in a negative-pressure isolation room whenever feasible to contain airborne infectious particles.
Question 5: During a mass casualty chemical exposure incident, the FIRST priority for incoming casualties before they enter the ED is:
- Airway management and IV access
- Decontamination with copious water (Correct answer)
- Administration of specific antidotes
- Triage using the START system
Correct answer: Decontamination with copious water
Decontamination must occur before patients enter the facility to prevent secondary contamination of healthcare workers and the clinical environment.
Question 6: Which cleaning agent is most appropriate for terminal disinfection of an ED bay after a patient with Clostridioides difficile infection?
- Alcohol-based wipes (70% isopropyl)
- Quaternary ammonium compounds
- Sodium hypochlorite (bleach) solution (Correct answer)
- Hydrogen peroxide vapor
Correct answer: Sodium hypochlorite (bleach) solution
C. difficile spores are resistant to alcohol and quaternary ammonium compounds; sodium hypochlorite is the recommended sporicidal agent for environmental decontamination.
Question 7: A healthcare worker is exposed to blood splash to the conjunctivae from an HIV-positive source. What is the estimated per-episode transmission risk without PEP?
- 0.09% (Correct answer)
- 0.3%
- 3%
- 10%
Correct answer: 0.09%
Mucous membrane exposure to HIV-positive blood carries an estimated transmission risk of approximately 0.09%, lower than percutaneous needlestick (0.3%).
FACEM Safety and Infection Control 2
A patient with suspected Ebola virus disease arrives in the ED.
Which PPE ensemble is required for healthcare workers performing direct patient care?