MRCPsych Safety and Infection Control 3 — Questions and Answers
Question 1: A psychiatrist is assessing a detained patient who becomes acutely agitated. Which de-escalation strategy should be attempted BEFORE physical restraint?
- Immediately administer rapid tranquillisation
- Use verbal de-escalation, offer choices, and reduce environmental stimulation (Correct answer)
- Summon security staff immediately
- Apply mechanical restraint as a precaution
Correct answer: Use verbal de-escalation, offer choices, and reduce environmental stimulation
NICE guidelines recommend verbal de-escalation techniques including calm communication, offering choices, and reducing stimuli before considering physical or pharmacological interventions.
Question 2: A staff nurse on an acute psychiatric ward is found to have active pulmonary tuberculosis. What is the MOST appropriate immediate action by the ward manager?
- Allow the nurse to continue working with an N95 mask
- Remove the nurse from clinical duties and refer to occupational health for assessment and contact tracing (Correct answer)
- Transfer the nurse to a non-clinical role within the same ward
- Notify the patient's relatives only
Correct answer: Remove the nurse from clinical duties and refer to occupational health for assessment and contact tracing
A healthcare worker with active pulmonary TB must be removed from clinical duties immediately, with occupational health leading assessment and contact tracing of exposed patients and staff.
Question 3: Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013, which of the following events on a psychiatric ward MUST be reported to the Health and Safety Executive (HSE)?
- A patient slipping on a wet floor with no injury
- A member of staff sustaining a fracture requiring hospital admission after a patient assault (Correct answer)
- A patient absconding from an open ward
- A minor medication error with no patient harm
Correct answer: A member of staff sustaining a fracture requiring hospital admission after a patient assault
Under RIDDOR, work-related fractures and injuries requiring hospital admission sustained by employees must be reported to the HSE.
Question 4: A patient on an acute psychiatric ward is found to have scabies. Which of the following is the MOST appropriate infection control response?
- Discharge the patient immediately to prevent ward outbreak
- Treat the patient with topical permethrin and notify close contacts for assessment and prophylactic treatment (Correct answer)
- Place the patient in airborne precautions isolation
- Treat all ward staff with oral ivermectin prophylactically without assessment
Correct answer: Treat the patient with topical permethrin and notify close contacts for assessment and prophylactic treatment
Scabies management requires treating the index case with permethrin and identifying close contacts for assessment and treatment to prevent ward outbreak.
Question 5: Which organisation in England is primarily responsible for receiving notifications of specific infectious diseases from clinicians under the Health Protection Regulations 2010?
- NHS England
- Care Quality Commission (CQC)
- UK Health Security Agency (UKHSA) via the local health protection team (Correct answer)
- General Medical Council (GMC)
Correct answer: UK Health Security Agency (UKHSA) via the local health protection team
Clinicians must notify the local health protection team (part of UKHSA) when they identify a notifiable disease under the Health Protection Regulations 2010.
Question 6: A psychiatric inpatient on clozapine develops a fever and productive cough. Blood tests show absolute neutrophil count 0.3 × 10⁹/L. What is the MOST immediate safety action?
- Increase the clozapine dose to maintain therapeutic levels
- Stop clozapine immediately and seek urgent haematological review (Correct answer)
- Add prophylactic G-CSF without stopping clozapine
- Reduce clozapine by 50% and repeat FBC in 1 week
Correct answer: Stop clozapine immediately and seek urgent haematological review
Clozapine must be stopped immediately if the ANC falls below 0.5 × 10⁹/L (severe neutropenia/agranulocytosis), and urgent haematological review is required.
Question 7: Which of the following best describes the role of the 'Caldicott Guardian' in an NHS psychiatric trust?
- A clinician responsible for all infection control policies
- A senior person responsible for protecting the confidentiality of patient information (Correct answer)
- A manager overseeing physical restraint training
- A pharmacist overseeing controlled drug prescribing
Correct answer: A senior person responsible for protecting the confidentiality of patient information
The Caldicott Guardian is a senior NHS professional responsible for protecting patient confidentiality and ensuring the appropriate use of patient information.
MRCPsych Safety and Infection Control 3
A psychiatrist is assessing a detained patient who becomes acutely agitated.
Which de-escalation strategy should be attempted BEFORE physical restraint?