22 Infection Control, Safety & Professional Role Practice Questions & Answers

1. 1. A technician holding gauze over a needle site at station 4 gets blood on both gloves, and is called to help at station 5. After removing the gloves, the technician sees blood on both hands. What should the technician do before touching the patient at station 5?

   • A.Put on a second pair of gloves over the first pair to save time during a busy shift
   • B.Rinse the gloved hands under running water and keep the same gloves for station 5
   • C.Wash the hands with soap and running water, dry them, and put on a new pair of gloves at station 5✓ Answer
   • D.Apply an alcohol-based hand rub to the visibly soiled hands and put on a new pair of gloves

   Hand hygiene between patients is the single most effective barrier to cross-transmission, and gloves are single-patient items that are never washed, rinsed, or reused. Alcohol-based hand rub is preferred only when hands are not visibly soiled; organic material such as blood interferes with alcohol's action, so visibly soiled hands must be washed with soap and running water. Double-gloving does not substitute for changing gloves and performing hand hygiene between patients.

   Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30); CDC Guideline for Hand Hygiene in Health-Care SettingsReport a problem with this question

2. 2. A technician is preparing to discontinue a treatment and remove the needles from a patient who has never had a bleeding problem and has no known bloodborne infection. Which personal protective equipment is most appropriate for this task?

   • A.Gloves and a gown, adding eye protection only if the patient is known to be positive for a bloodborne virus
   • B.Gloves, a protective gown or barrier, and a mask worn together with eye protection such as goggles or a face shield✓ Answer
   • C.Gloves only, because the patient has no known bloodborne infection and no history of bleeding
   • D.Gloves and a surgical mask, since a mask alone is sufficient when no spray is expected

   Initiation and discontinuation of dialysis are the moments when blood spray and splash are most likely, so a mask combined with eye protection, plus gloves and a protective gown, is indicated for every patient. Standard precautions are applied on the basis of the anticipated exposure, not on the basis of a patient's known or suspected diagnosis, because any patient may carry an undetected bloodborne pathogen.

   Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30); OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030Report a problem with this question

3. 3. A technician carried extra gauze packets, tape, and a sealed alcohol-swab box into a patient's station at the start of treatment. At the end of the treatment several of these items are unopened and unused. What should the technician do with them?

   • A.Place them on the common medication and supply cart so the next station can use them
   • B.Move them directly to the neighboring station for the next patient, since the packages are intact
   • C.Return the unopened items to the clean supply room, since sealed packaging was never contaminated
   • D.Keep them dedicated to that patient at that station or discard them; they must not be returned to the clean supply area✓ Answer

   In a dialysis unit each station is treated as that patient's exclusive treatment area, and anything taken into it is considered contaminated by the station environment even if the wrapper was never opened. Items must therefore be dedicated to that single patient, discarded, or cleaned and disinfected before they return to a common clean area, and a common supply or medication cart must not be moved from station to station.

   Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30)Report a problem with this question

4. 4. A prefilled saline syringe was used to flush one patient's bloodline and about half of the solution remains in the syringe. The patient at the next station now needs a flush. What is the correct action?

   • A.Cap the syringe and keep it in a pocket for the same patient's next treatment
   • B.Use the remaining solution for the second patient because the syringe never touched that patient's blood
   • C.Change to a sterile needle on the same syringe and use the remaining solution for the second patient
   • D.Discard the used syringe and obtain a new single-use syringe and flush solution prepared in the designated clean area✓ Answer

   One needle, one syringe, one time: a syringe that has entered a patient's line is contaminated by backflow even when no blood is visible, so changing only the needle does not make it safe for another patient. Injectable solutions must be prepared in a designated clean area away from the treatment stations and delivered individually, and supplies or vials are never carried in a pocket.

   Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30); CDC safe injection practicesReport a problem with this question

5. 5. A patient starting chronic hemodialysis is found to be hepatitis B surface antigen positive. Which arrangement best reflects the required infection-control practice for this patient?

   • A.Use a dedicated machine only, allowing the assigned staff member to also care for other patients on that shift
   • B.Dialyze at any open station using standard precautions, since standard precautions apply to every patient
   • C.Dialyze in a separate room or segregated area on a dedicated machine with dedicated supplies, and assign staff who do not care for hepatitis B susceptible patients on the same shift✓ Answer
   • D.Dialyze on the last shift of the day at any station, then disinfect the machine more thoroughly than usual

   Hepatitis B virus is unusually stable outside the body, surviving in dried blood on environmental surfaces for days, and it circulates at a very high titer, so a small inoculum can transmit infection. For that reason hepatitis B surface antigen positive patients require isolation measures in addition to standard precautions: a separate room or segregated area, a dedicated machine, dedicated supplies and medications, and staff who do not also care for susceptible patients during the same shift. Their dialyzers are also not reprocessed.

   Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30)Report a problem with this question

6. 6. A patient in the unit is reported to be hepatitis C antibody positive and anxiously asks the technician whether this means being moved to the isolation room with a machine of his own. Which response is most accurate?

   • A.He can be treated at any station with standard precautions; a separate room and a dedicated machine are not required, and the nurse can answer his further questions✓ Answer
   • B.He must be moved to a separate room on a dedicated machine, just as for hepatitis B surface antigen positive patients
   • C.He can stay in the open unit but must be scheduled on the last shift of the day at the end station
   • D.He can stay in the open unit but needs a dedicated machine that no other patient may use

   Hepatitis C and HIV positive patients do not require isolation, a separate room, a dedicated machine, or a dedicated staff assignment, because consistent application of standard precautions prevents transmission of these less environmentally stable viruses; only hepatitis B surface antigen positive patients require added isolation. Over-generalizing hepatitis B isolation to hepatitis C also risks stigmatizing the patient, and clinical questions about his diagnosis belong to the nurse.

   Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30)Report a problem with this question

7. 7. A newly hired technician with occupational exposure to blood tells the educator that he does not want the hepatitis B vaccination series right now. Which statement about this situation is correct?

   • A.The employer must offer the series at no cost, the refusal is documented on the required declination form, and he may accept the vaccination later at any time while still covered✓ Answer
   • B.Refusal is final, and he may not be offered the vaccination again during his employment
   • C.He must be reassigned away from all direct patient care until he completes the series
   • D.He may refuse, but he must then pay for the series himself if he later changes his mind

   The employer bears the cost of protecting workers from bloodborne hazards, so hepatitis B vaccination, personal protective equipment, and post-exposure evaluation are provided at no cost to the employee. An employee may decline the vaccine, but the declination must be documented on the standard form, and the right to receive the vaccination later at no charge remains open as long as the employee still has occupational exposure.

   Source: OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030Report a problem with this question

8. 8. Immediately after removing a fistula needle fitted with a safety device, what should the technician do with the needle?

   • A.Carefully recap the needle with one hand and then walk it to the sharps container by the nurses' station
   • B.Bend the needle so it cannot be reused and press it into the sharps container opening
   • C.Activate the safety device and place the needle, without recapping, directly into the puncture-resistant sharps container at that station✓ Answer
   • D.Lay it on the treatment tray until both needles are out, then dispose of both together

   Most sharps injuries happen between use and disposal, so a contaminated needle is placed immediately into a puncture-resistant, leak-proof, labeled sharps container located as close as practical to the point of use. Engineered safety features must be activated, and needles are never recapped, bent, sheared, or carried around; containers are replaced before they become overfilled and are never reached into.

   Source: OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030Report a problem with this question

9. 9. A technician sustains a needlestick from a used fistula needle while cleaning up a station. Which sequence of actions is correct?

   • A.Finish the shift, then report the incident at the end of the day so patient care is not interrupted
   • B.Wash the site with soap and water, report the exposure to the supervisor immediately, and undergo confidential post-exposure evaluation and follow-up provided at no cost✓ Answer
   • C.Ask the patient's serology status first and report the exposure only if the patient tests positive
   • D.Squeeze the wound to make it bleed, pour a bleach solution over it, and continue working

   Exposure response is a defined process, not a judgment call: wash the site, report at once, and obtain medical evaluation, because post-exposure prophylaxis is time-critical and loses effectiveness with delay. The employer must provide the confidential evaluation, source testing where the law allows, follow-up, and the sharps injury log entry at no cost to the employee. Squeezing the wound or applying caustic agents is not recommended and can worsen tissue injury.

   Source: OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030Report a problem with this question

10. 10. During a treatment, blood drips onto the arm of the dialysis chair and onto the countertop beside it. Which action by the technician is best?

    • A.Put on gloves and eye protection, remove the visible blood with a cleaning step first, then apply a disinfectant registered for tuberculocidal activity and let the surface stay wet for the labeled contact time and air dry✓ Answer
    • B.Spray disinfectant over the blood and wipe the surface completely dry right away so no one touches a wet surface
    • C.Wipe the blood away with an alcohol pad, since alcohol evaporates quickly and leaves no residue
    • D.Cover the spill with a towel and clean the area thoroughly after the patient has been disconnected at the end of treatment

    Cleaning must precede disinfection because blood and other organic soil physically shield microorganisms and chemically inactivate the disinfectant, and the product then only works if the surface remains visibly wet for the contact time stated on its label, so wiping it dry early defeats the process. Visible blood raises the requirement to a hospital disinfectant registered for tuberculocidal activity with hepatitis B and HIV label claims rather than a routine low-level product or an alcohol pad, and visible blood is cleaned up at once rather than at the end of treatment.

    Source: CDC Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (incorporated by reference at 42 CFR 494.30); OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030Report a problem with this question

11. 11. While setting up, a technician notices that the outer insulation of a dialysis machine's power cord is cracked and the wires beneath are visible. Considering why a hemodialysis patient is especially vulnerable to electrical hazards, what should the technician do?

    • A.Use the machine for this treatment since it powers on normally, and write a work order at the end of the day
    • B.Remove the machine from service, label it as out of order, and report it to the nurse and the biomedical technician for repair✓ Answer
    • C.Move the machine to a different outlet on another circuit and use it as usual
    • D.Wrap the damaged section in electrical tape and continue to use the machine for the shift

    A patient on hemodialysis is connected through needles and a saline-filled extracorporeal circuit that forms a low-resistance electrical path from the machine toward the heart, bypassing the protective resistance of dry skin, so even leakage current too small to be felt can be hazardous. Damaged cords and any equipment suspected of an electrical fault are taken out of service, tagged, and referred to the biomedical technician; equipment must be maintained and operated according to the manufacturer's recommendations, and improvised repairs such as taping are not acceptable.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.60 (Condition: Physical environment); NNCC CCHT content outline, Dialysis Practice Area III (Environment)Report a problem with this question

12. 12. A technician sees flames coming from a linen cart in the corridor outside the treatment floor while patients are on treatment. What should the technician do first?

    • A.Move anyone in immediate danger away from the fire and activate the alarm to alert the staff and the fire department✓ Answer
    • B.Begin disconnecting every patient in the unit from the machines
    • C.Close all the doors in the corridor and wait for the charge nurse to give directions
    • D.Get the nearest fire extinguisher and begin spraying at the top of the flames

    Fire response follows rescue, alarm, confine, and then extinguish or evacuate: people in immediate danger are moved first and the alarm is raised so that help is on the way before anyone attempts to fight the fire. If an extinguisher is used, it is aimed at the base of the flames rather than the top, and mass disconnection of patients is an evacuation step taken on the charge nurse's direction, not the first response to a small contained fire.

    Source: NNCC CCHT content outline, Dialysis Practice Area III (prepare for and respond to environmental emergencies during treatment); CMS ESRD Conditions for Coverage, 42 CFR 494.60 (Condition: Physical environment)Report a problem with this question

13. 13. The unit must be evacuated immediately and a patient dialyzing through an arteriovenous fistula has to be taken off the machine as fast as safely possible. Which action is correct?

    • A.Cut the needle tubing close to the skin so the needles can be left in place and taped down
    • B.Ask each patient, including those dialyzing through a central venous catheter, to disconnect themselves so staff can help others
    • C.Clamp the bloodlines on the needle side and then on the machine side, disconnect between the clamps, and if lines must be cut, cut only the thick bloodlines and never the needle tubing✓ Answer
    • D.Rinse the blood back to the patient completely before disconnecting, no matter how long the rinseback takes

    Clamping before disconnecting and disconnecting between the clamps keeps blood from escaping and keeps air from entering the circuit, which is why the needle-side clamps go on first. Cutting the needle tubing would leave an open path from the vascular access and cause rapid blood loss, so only the thicker bloodlines are ever cut. In a true evacuation the blood is generally not rinsed back because speed protects the patient more than the returned volume, and patients with a central venous catheter must never disconnect themselves because of the risk of bleeding and air embolism.

    Source: NNCC CCHT content outline, Dialysis Practice Area III (emergency evacuation and environmental emergencies); CMS ESRD Conditions for Coverage, 42 CFR 494.60 (Condition: Physical environment)Report a problem with this question

14. 14. A weak patient who cannot bear much weight must be moved from a wheelchair to the dialysis chair. Which approach best protects both the patient and the technician?

    • A.Ask the patient to hold onto the technician's neck and pull himself up while the technician bends over him
    • B.Bend at the waist and twist toward the dialysis chair so the patient's feet do not have to move
    • C.Lock the wheels of both chairs, explain the move, apply a transfer belt, get a second staff member or an assistive device, and lift with the knees while keeping the back straight and the patient close✓ Answer
    • D.Lift the patient quickly and alone under the armpits to spare the patient a long transfer

    Safe patient handling combines a stable base for the worker with a controlled, predictable move for the patient: locked wheels prevent the chair from rolling away, a transfer belt gives a secure hold that does not stress the patient's shoulders, and lifting with the knees while keeping the load close and pivoting with the feet avoids the twisted, flexed spine that causes most back injuries. Getting help or using a device is expected whenever the patient cannot reliably bear weight.

    Source: NNCC CCHT content outline, Dialysis Practice Area III (use proper body mechanics; maintain an environment that reduces fall risk)Report a problem with this question

15. 15. A patient in the open treatment area leans over and asks the technician why the man in the corner room dialyzes alone on his own machine. What is the most appropriate response?

    • A.Say that patients with hepatitis are always placed in that room, without giving the man's name
    • B.Tell the patient to ask the man in the corner room about it directly at the end of the shift
    • C.Explain in general terms that the man has an infection that requires his own machine
    • D.Politely explain that information about another patient cannot be shared, redirect the conversation, and tell the nurse if the patient has further concerns✓ Answer

    Health information may be used or disclosed only as needed by those involved in that patient's care, and infection or serology status is among the most sensitive information a dialysis patient has. On an open floor an explanation that seems vague still identifies the patient, because the questioner can already see who is in that room, so any hint about a diagnosis is a disclosure. Directing another patient to interrogate him also fails to protect his privacy and dignity.

    Source: HIPAA Privacy Rule minimum necessary standard, 45 CFR 164.502; CMS ESRD Conditions for Coverage, 42 CFR 494.70 (Condition: Patients' rights)Report a problem with this question

16. 16. With about forty-five minutes of prescribed treatment time remaining, a patient states that he feels fine but wants to come off the machine now because of a ride home. What should the technician do?

    • A.Tell the patient that stopping early is not allowed and continue the treatment to the prescribed time
    • B.Warn the patient that repeatedly leaving early can lead to being discharged from the facility
    • C.Notify the nurse so the risks can be explained by the appropriate team member, respect the patient's right to refuse or stop treatment, and document the request and the notification✓ Answer
    • D.Take the patient off immediately without telling anyone, since it is the patient's own decision

    A patient has the right to be informed about and participate in care and to refuse or discontinue treatment, so the technician neither coerces the patient nor acts alone. The correct pathway is to inform the nurse, who assesses the patient and provides the clinical explanation of the consequences of a shortened treatment, and then to document the request objectively. Implying that a patient's choices will cost him his place in the facility is a threat, not education.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.70 (Condition: Patients' rights)Report a problem with this question

17. 17. A patient tells the technician that she is unhappy with how a staff member spoke to her, but she is afraid that complaining will affect her treatment. Which response is most appropriate?

    • A.Listen without arguing, tell her she may file a grievance internally or externally, including anonymously, without reprisal or denial of services, and inform the nurse or social worker✓ Answer
    • B.Tell her that grievances must be signed and submitted in person to the facility administrator
    • C.Advise her to wait and see whether it happens again before saying anything to anyone
    • D.Reassure her that the staff member did not mean it and suggest she let the matter go

    Patients must be informed of the facility's internal grievance process and of external mechanisms, including how to contact the ESRD Network and the State survey agency, and they may file personally, anonymously, or through a representative without reprisal or denial of services. Because fear of retaliation is exactly what the rule protects against, telling the patient it must be signed and delivered in person, or discouraging her from raising it, undermines a protected right rather than resolving the concern.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.70 (Condition: Patients' rights)Report a problem with this question

18. 18. A technician notices unexplained bruising on a patient's upper arms over several treatments, and the patient becomes quiet and fearful whenever a particular relative arrives to pick her up. What should the technician do?

    • A.Tell the patient privately that she should leave the situation and offer to drive her home
    • B.Document the objective observations and report the concern promptly to the nurse or supervisor according to facility policy✓ Answer
    • C.Wait until there is clearer evidence before mentioning it, to avoid accusing anyone unfairly
    • D.Ask the relative directly in the waiting area how the bruises happened

    Patients have the right to be free from abuse and neglect, and the technician's obligation is to observe, document factually, and report through the facility's channel so that the nurse, social worker, and administration can act and involve outside authorities as required. Confronting a relative can escalate the situation and endanger the patient, delaying a report leaves the patient at risk, and driving a patient home crosses a professional boundary.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.70 (Condition: Patients' rights)Report a problem with this question

19. 19. A long-term patient hands the technician an envelope with cash as a holiday thank-you and later sends the technician a social media friend request. What is the most appropriate action?

    • A.Accept the cash but share it with the whole care team, and ignore the friend request
    • B.Decline both warmly, explain that the professional relationship and facility policy do not allow it, and inform the nurse or manager✓ Answer
    • C.Accept the friend request but agree never to discuss anything medical there, and return the cash
    • D.Accept both quietly, since refusing would insult the patient and damage the therapeutic relationship

    The caregiver and patient relationship is therapeutic rather than social, and gifts of money, personal social contact, and outside favors blur that boundary, create the appearance of favoritism among patients, and make it harder to act on clinical concerns objectively. Declining kindly, giving the reason, and telling the supervisor keeps the relationship intact while documenting that nothing was concealed.

    Source: NNCC CCHT content outline, Dialysis Practice Area IV (maintain appropriate caregiver and patient relationships)Report a problem with this question

20. 20. A technician realizes that a set of vital signs was charted on the wrong patient's treatment record. How should the entry be corrected?

    • A.Erase the entry completely so the record does not look confusing to the next reviewer
    • B.Leave the entry as it is and simply write the correct values on the other patient's record
    • C.Draw a single line through the entry so it remains readable, write the correction, and initial and date the change✓ Answer
    • D.Use correction fluid over the entry and write the correct values in the same space

    The medical record is a legal document, so an error is corrected in a way that shows both what was originally written and who changed it and when; a single line, the correction, initials, and the date preserve that audit trail. Erasing, writing over, or obliterating an entry destroys the original information and can make the entire record look altered, and leaving a known error uncorrected means another clinician may act on data that belongs to a different patient.

    Source: NNCC CCHT content outline, Dialysis Practice Area IV (document findings and interventions); CMS ESRD Conditions for Coverage, Condition: Medical recordsReport a problem with this question

21. 21. A machine alarm has interrupted a treatment several times, and the patient asks the technician to widen the alarm limits and increase fluid removal so he can finish on time. What should the technician do?

    • A.Widen the alarm limits slightly, since the alarms are clearly a nuisance and the patient feels well
    • B.Decline to change the prescribed settings or the alarm limits, troubleshoot within the scope of his training, and report the situation to the nurse, who follows the physician's prescription✓ Answer
    • C.Silence the alarm each time it sounds and continue the treatment without telling anyone
    • D.Increase the fluid removal rate so the treatment can end at the requested time

    The dialysis prescription, including fluid removal, is set by the physician, and alarm limits exist to detect the conditions the technician cannot see; widening them or silencing a repeating alarm removes the safety net rather than solving the cause. The technician works under the supervision of the nurse, collects and reports data, and does not change the prescription or practice beyond the scope of training, so the correct action is to troubleshoot as trained and notify the nurse.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.140 (Condition: Personnel qualifications); NNCC CCHT content outline, Dialysis Practice Area IV (differentiate roles and responsibilities of care-team members)Report a problem with this question

22. 22. A patient starting her first week of hemodialysis is tearful during setup and asks the technician, "Am I going to die on this machine?" What is the best response by the technician?

    • A.Reassure her that there is nothing at all to worry about and that everything will be fine
    • B.Acknowledge that starting dialysis is frightening, invite her to say more, listen without interrupting, and inform the nurse so the team can address her concerns✓ Answer
    • C.Change the subject to something cheerful so she does not dwell on frightening thoughts
    • D.Quote survival figures for dialysis patients so she can see the odds are in her favor

    Therapeutic communication begins by acknowledging the feeling and using open-ended invitations and silence so the patient can say what she actually fears, which is the only way the team learns what she needs. False reassurance and changing the subject close the conversation and signal that the fear is unwelcome, and quoting statistics answers a prognosis question that is outside the technician's scope; concerns of this kind are referred to the nurse, who can involve the social worker and the physician.

    Source: NNCC CCHT content outline, Dialysis Practice Area IV (use appropriate verbal and nonverbal communication techniques; recognize and report the need for patient education)Report a problem with this question

Practice questions based on the NNCC CCHT content outline, CDC recommendations for hemodialysis settings, and the OSHA Bloodborne Pathogens Standard. Not affiliated with or endorsed by NNCC, and not medical advice. Machine settings, dialysate composition, flow rates, alarm thresholds, water-quality limits and laboratory targets are deliberately never the answer to a question here — those are set by your machine's manufacturer, your facility's protocol and the physician's prescription. Always follow your facility's policies and your patient's prescribed treatment. About the CCHT exam (NNCC) →