NRCMA Infection Control 2 — Questions and Answers
Question 1: Which level of disinfection is required for semi-critical instruments that contact mucous membranes but do not penetrate tissue?
- Low-level disinfection
- High-level disinfection (Correct answer)
- Sterilization
- Intermediate-level disinfection
Correct answer: High-level disinfection
Semi-critical items such as vaginal specula and endoscopes contact mucous membranes and require high-level disinfection to eliminate all microorganisms except bacterial spores.
The Spaulding classification: critical items (penetrate sterile tissue — require sterilization), semi-critical items (contact mucous membranes — require high-level disinfection), non-critical items (contact intact skin — require low to intermediate disinfection). High-level disinfectants include glutaraldehyde and ortho-phthalaldehyde (OPA).
Question 2: The purpose of an autoclave's biological indicator (spore test) is to:
- Measure the internal temperature of each cycle
- Confirm that sterilization conditions were sufficient to kill the most resistant organisms (Correct answer)
- Change color when the package is exposed to steam
- Indicate the date and time of sterilization
Correct answer: Confirm that sterilization conditions were sufficient to kill the most resistant organisms
Biological indicators contain Geobacillus stearothermophilus spores; if they are killed, it confirms the autoclave achieved true sterilization.
Autoclave validation requires physical (temperature/pressure gauges), chemical (indicator tapes), and biological (spore tests) monitoring. Biological indicators are the gold standard. OSHA and AAMI recommend weekly spore testing. A failed biological indicator requires removing all items processed since the last passing test.
Question 3: When removing PPE after patient care, which item is removed LAST?
- Gloves
- Gown
- Goggles or face shield
- Mask or respirator (Correct answer)
Correct answer: Mask or respirator
The CDC's recommended doffing sequence removes the mask/respirator last because it protects the respiratory tract from airborne contamination during doffing.
CDC doffing sequence: (1) gloves — most contaminated, (2) gown, (3) goggles/face shield, (4) mask or respirator. Each step is followed by hand hygiene. Incorrect doffing order is a major source of healthcare worker self-contamination.
Question 4: MRSA requires which transmission-based precaution?
- Airborne precautions
- Droplet precautions
- Contact precautions (Correct answer)
- Reverse isolation
Correct answer: Contact precautions
MRSA spreads primarily through direct and indirect contact with colonized skin or contaminated surfaces, requiring contact precautions.
Contact precautions require gloves and gown upon room entry, a private room or cohorting, and dedicated patient care equipment. Airborne precautions are for tuberculosis and measles. Droplet precautions apply to influenza and meningococcal disease.
Question 5: An accidental needlestick injury should be managed FIRST by:
- Applying a tourniquet above the injury site
- Immediately washing the site with soap and water (Correct answer)
- Applying a sterile dressing and leaving it alone
- Notifying risk management before doing anything else
Correct answer: Immediately washing the site with soap and water
Immediate washing with soap and water for at least 15 seconds removes potential contaminants and is the first step after any needlestick.
After a needlestick: (1) wash with soap and water for at least 15 seconds; (2) report to supervisor and occupational health; (3) document; (4) have source patient tested for HIV, HBV, HCV; (5) receive PEP if indicated within 2 hours. Tourniquets and squeezing the wound are not recommended.
Question 6: Medical waste that includes blood-soaked materials, sharps, and pathological waste is classified as:
- Municipal solid waste
- Hazardous chemical waste
- Regulated (infectious/biohazardous) medical waste (Correct answer)
- Radioactive waste
Correct answer: Regulated (infectious/biohazardous) medical waste
Blood-soaked materials, sharps, and pathological specimens are regulated medical waste requiring special containers, labeling, and disposal by licensed vendors.
Regulated medical waste (RMW) includes sharps, liquid blood, pathological waste, and items saturated with blood. RMW must be placed in puncture-resistant sharps containers or leak-proof red bags marked with the biohazard symbol. Disposal is regulated by OSHA's Bloodborne Pathogen Standard and state environmental agencies.
NRCMA Infection Control 2
Which level of disinfection is required for semi-critical instruments that contact mucous membranes but do not penetrate tissue?