FACEM Safety and Infection Control 3 — Questions and Answers
Question 1: A child with suspected meningococcal meningitis is brought to the ED. Which isolation precaution category should be initiated immediately?
- Airborne precautions
- Contact precautions only
- Droplet precautions (Correct answer)
- Reverse isolation
Correct answer: Droplet precautions
Neisseria meningitidis is transmitted via large respiratory droplets, requiring droplet precautions (surgical mask within 1 meter) until 24 hours of effective antibiotic therapy.
Question 2: What is the recommended hand hygiene technique when hands are visibly soiled with blood or body fluids?
- Alcohol-based hand rub for 20 seconds
- Soap and water for at least 40-60 seconds (Correct answer)
- Alcohol-based hand rub followed by soap and water
- Antimicrobial wipes
Correct answer: Soap and water for at least 40-60 seconds
When hands are visibly soiled, soap and water handwashing for 40-60 seconds is required, as alcohol-based rubs do not effectively remove organic material.
Question 3: Which of the following is a correct 'moment' for hand hygiene according to the WHO Five Moments framework in emergency care?
- After removing PPE and before leaving the patient zone (Correct answer)
- Before entering the hospital building
- After each patient transport
- Before reviewing imaging results at a workstation outside the patient zone
Correct answer: After removing PPE and before leaving the patient zone
WHO Moment 5 is 'after contact with patient surroundings,' which includes after removing PPE within the patient zone before leaving, to prevent transferring organisms.
Question 4: A fit-test for an N95 respirator confirms a poor seal. What is the most appropriate immediate action?
- Proceed with use and double-layer with a surgical mask
- Select a different N95 model and repeat the fit-test (Correct answer)
- Use a surgical mask instead for airborne isolation
- Report to occupational health in one week
Correct answer: Select a different N95 model and repeat the fit-test
A failed fit-test means that specific N95 model does not form an adequate seal; the worker must be tested with alternative models until a passing fit is achieved before caring for airborne-precaution patients.
Question 5: Which intervention most effectively reduces central line-associated bloodstream infections (CLABSIs) during emergency placement of central venous catheters?
- Using antibiotic-impregnated catheters for all insertions
- Performing the procedure under full sterile barrier precautions (cap, mask, gown, gloves, large drape) (Correct answer)
- Applying povidone-iodine to the insertion site only
- Replacing all emergently placed lines within 24 hours
Correct answer: Performing the procedure under full sterile barrier precautions (cap, mask, gown, gloves, large drape)
Maximal sterile barrier precautions during CVC insertion are a core bundle element proven to reduce CLABSI rates; replacing emergently placed lines within 24-48 hours is also recommended but is secondary.
Question 6: A patient presents after a bite from another human. Which pathogen is the primary concern driving the choice of prophylactic antibiotics?
- Staphylococcus aureus
- Pasteurella multocida
- Eikenella corrodens (Correct answer)
- Streptococcus pyogenes
Correct answer: Eikenella corrodens
Eikenella corrodens is a key pathogen in human bite wounds and is resistant to many first-generation cephalosporins; amoxicillin-clavulanate covers this organism and is the preferred prophylactic agent.
Question 7: In an ED outbreak of norovirus affecting multiple staff, what is the most critical infection control measure to limit further spread?
- Universal N95 use by all staff
- Cohorting affected staff and reinforcing hand hygiene with soap and water (Correct answer)
- Environmental disinfection with alcohol-based wipes only
- Prophylactic antiviral therapy for exposed staff
Correct answer: Cohorting affected staff and reinforcing hand hygiene with soap and water
Norovirus is spread by fecal-oral route; excluding symptomatic staff, cohorting, and enforcing soap-and-water hand hygiene (alcohol rubs are less effective) are the key outbreak control measures.
FACEM Safety and Infection Control 3
A child with suspected meningococcal meningitis is brought to the ED.
Which isolation precaution category should be initiated immediately?