22 Safety & Infection Control Practice Questions & Answers

1. 1. Under the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030), how often must the employer review and update the written Exposure Control Plan?

   • A.At least every three years, and whenever a new employee is hired
   • B.Only after an exposure incident, since the plan is otherwise unchanged
   • C.At least annually, and whenever new tasks or procedures affect exposure✓ Answer
   • D.At least every five years, unless the facility changes owners or relocates

   The standard requires the written plan to be reviewed and updated at least annually and whenever new or modified tasks and procedures affect occupational exposure. That annual review is also where the employer must document its consideration of safer engineered sharps devices, so an out-of-date plan is itself a violation.

   Source: OSHA 29 CFR 1910.1030(c)(1)(iv)Report a problem with this question

2. 2. When an employer evaluates and selects safer needle devices as required by 29 CFR 1910.1030, whose input must be documented in the Exposure Control Plan?

   • A.State health inspectors who audit the laboratory once every calendar year
   • B.Non-managerial employees who actually use the devices in direct patient care✓ Answer
   • C.Managers of the phlebotomy department together with the facility safety officer
   • D.Clinical representatives from the device manufacturer and the purchasing agent

   The Needlestick Safety and Prevention Act added a requirement that the identification and selection of safer devices include input from non-managerial employees who are potentially exposed and who actually perform the procedures, and that this solicitation be documented in the plan. Input from managers, vendors, or inspectors does not satisfy it.

   Source: OSHA 29 CFR 1910.1030(c)(1)(v); Needlestick Safety and Prevention Act (2000)Report a problem with this question

3. 3. A newly hired phlebotomist has occupational exposure to blood. Under 29 CFR 1910.1030, when must the employer make the hepatitis B vaccination series available?

   • A.Within 90 days of hire, with the cost shared equally by both parties
   • B.Within 10 working days of the first exposure incident that is reported
   • C.Within 10 working days of initial assignment, at no cost to the employee✓ Answer
   • D.Within 30 calendar days of initial assignment, at the employee's own cost

   The vaccine must be offered after training and within 10 working days of initial assignment to a job with occupational exposure, at no cost, and during working hours. Waiting for an exposure incident defeats the purpose, since the series protects before contact occurs.

   Source: OSHA 29 CFR 1910.1030(f)(2)(i)Report a problem with this question

4. 4. A phlebotomist signs the OSHA declination form refusing the hepatitis B vaccine. Six months later she changes her mind. What must the employer do?

   • A.Provide the vaccination series at that time at no cost to the employee✓ Answer
   • B.Wait until her annual bloodborne pathogens retraining to offer it again
   • C.Require her to pay for the series herself because she declined in writing
   • D.Document that the signed declination is permanent for her employment

   The declination statement in Appendix A explicitly preserves the employee's right to receive the vaccine later at no charge while she still has occupational exposure. A signed refusal records a decision at one moment; it does not waive the benefit permanently.

   Source: OSHA 29 CFR 1910.1030(f)(2)(iv) and Appendix AReport a problem with this question

5. 5. Under the Bloodborne Pathogens Standard, how long must an employer keep bloodborne pathogens training records and employee medical records?

   • A.Training records 3 years; medical records the duration of employment plus 30 years✓ Answer
   • B.Training records 3 years; medical records for 3 years after the employee leaves
   • C.Training records 30 years; medical records the duration of employment plus 3 years
   • D.Training records 5 years; medical records the duration of employment plus 10 full years

   Training records document a short-lived obligation that repeats every year, so 3 years is enough, while medical records must outlive the long latency of hepatitis and HIV disease and follow the general employee-exposure rule of employment plus 30 years. Reversing the two numbers is the classic error.

   Source: OSHA 29 CFR 1910.1030(h)(1)-(2); 29 CFR 1910.1020Report a problem with this question

6. 6. After an exposure incident, the evaluating healthcare professional sends a written opinion to the employer. Which statement about that written opinion is correct under 29 CFR 1910.1030?

   • A.The opinion is filed only in the employee's confidential medical record and is never released
   • B.The employer receives the full medical evaluation, including every diagnosis the professional made
   • C.The employee receives a copy within 30 days, and the opinion lists the source patient's test results in full
   • D.The employee receives a copy within 15 days, and the opinion covers only vaccination status and notification✓ Answer

   The employer must obtain and give the employee a copy of the written opinion within 15 days of the completed evaluation, and the opinion may state only whether hepatitis B vaccination is indicated or was received and that the employee was informed of results needing further evaluation. Everything else stays confidential between employee and clinician.

   Source: OSHA 29 CFR 1910.1030(f)(5)Report a problem with this question

7. 7. Which specimen is considered other potentially infectious material (OPIM) under the OSHA Bloodborne Pathogens Standard?

   • A.Sweat collected from a patient during an exercise stress test
   • B.Urine from a routine clean-catch midstream collection cup
   • C.Cerebrospinal fluid drawn during a lumbar puncture procedure✓ Answer
   • D.Tears collected on filter paper during a dry-eye evaluation

   OPIM is defined to include cerebrospinal, synovial, pleural, pericardial, peritoneal and amniotic fluid, semen and vaginal secretions, and unfixed human tissue. Sweat is excluded outright, and tears, urine, saliva and vomit fall under the standard only when they are visibly contaminated with blood.

   Source: OSHA 29 CFR 1910.1030(b), definition of other potentially infectious materialsReport a problem with this question

8. 8. A phlebotomist sustains a needlestick from a contaminated needle. What is the first action she should take?

   • A.Scrub the site with a household bleach solution before washing
   • B.Wash the puncture site with soap and running water right away✓ Answer
   • C.Squeeze the site firmly to force blood and pathogens out of it
   • D.Notify the supervisor and complete the incident report first

   Immediate washing with soap and running water physically removes inoculated material and is the only step that reduces what is still at the wound; reporting and the confidential medical evaluation follow immediately afterward. Squeezing the wound and caustic agents such as bleach damage tissue without any evidence of reducing transmission.

   Source: OSHA 29 CFR 1910.1030(d)(2)(v)-(vi), (f)(3); CDC post-exposure management guidanceReport a problem with this question

9. 9. The OSHA Bloodborne Pathogens Standard requires engineering controls to be used before work practice controls. Which of the following is an engineering control?

   • A.A policy of washing hands immediately after removing used gloves
   • B.A rule that used needles are never recapped by any two-handed method
   • C.A face shield worn whenever splashing of blood is anticipated
   • D.A blood collection needle with a retractable shield that covers the tip after use✓ Answer

   Engineering controls isolate or remove the hazard from the workplace through the device itself, so a self-sheathing or retracting needle qualifies. Rules about recapping and handwashing are work practice controls, and a face shield is personal protective equipment, both of which sit lower in the hierarchy because they depend on human behavior.

   Source: OSHA 29 CFR 1910.1030(b) definitions and (d)(2)(i)Report a problem with this question

10. 10. Under 29 CFR 1910.1030, when may a contaminated needle be recapped?

    • A.Whenever the phlebotomist uses two hands and keeps the cap steady
    • B.Only when no alternative is feasible, using a one-handed technique✓ Answer
    • C.Whenever the needle must be carried to a sharps container elsewhere
    • D.Only when the needle will be reused for a second draw on the patient

    The standard forbids bending, shearing, breaking and recapping contaminated needles, and allows recapping only where no alternative is feasible or the procedure itself requires it, and then only by a one-handed scoop or a mechanical holding device. Two-handed recapping points the needle at the hand holding the cap and is never permitted.

    Source: OSHA 29 CFR 1910.1030(d)(2)(vii)Report a problem with this question

11. 11. Which practice meets the OSHA requirements for a sharps disposal container in a drawing area?

    • A.Pressing sharps down by hand whenever the container looks nearly full
    • B.Storing it inside a locked cabinet away from the patient chair
    • C.Emptying and disinfecting it for reuse at the end of each shift
    • D.Keeping it upright and replacing it before it is overfilled✓ Answer

    Sharps containers must be closable, puncture-resistant, leakproof, labeled or color-coded, kept upright, located as close as feasible to the area of use, and replaced routinely rather than allowed to overfill. Locking one away defeats immediate point-of-use disposal, and reaching in or reprocessing a container exposes the worker to the sharps it holds.

    Source: OSHA 29 CFR 1910.1030(d)(4)(iii)(A)Report a problem with this question

12. 12. A contaminated capillary tube shatters on the counter. How should the phlebotomist pick up the broken glass?

    • A.With gloved fingertips, then place it in a red biohazard bag
    • B.With double gloves and forceps, then rinse it for the reuse bin
    • C.With a brush and dustpan, then place it in a sharps container✓ Answer
    • D.With a damp paper towel, then discard it in the regular trash

    Broken contaminated glass is a contaminated sharp and must never be picked up directly with the hands, even gloved, because gloves do not stop a laceration; it is cleaned up by mechanical means such as a brush and dustpan, tongs or forceps and discarded in a sharps container. Rinsing it for reuse or putting it in general trash exposes housekeeping staff.

    Source: OSHA 29 CFR 1910.1030(d)(4)(ii)(D)Report a problem with this question

13. 13. A phlebotomist finishes a draw on a patient in contact precautions for Clostridioides difficile. What hand hygiene is required after glove removal?

    • A.Washing with plain water only, because soap irritates frequently washed skin
    • B.Rubbing with alcohol gel twice, because a double application kills spores
    • C.Rubbing with alcohol-based hand gel, because it acts faster than washing
    • D.Washing with soap and running water, because alcohol does not kill the spores✓ Answer

    Alcohol-based hand rubs are not sporicidal, so hands contaminated with a spore-forming organism such as C. difficile or norovirus must be washed with soap and running water, where friction and rinsing physically remove the spores. Surfaces in the same room need a bleach-based or other sporicidal disinfectant for the same reason.

    Source: CDC Guideline for Hand Hygiene in Health-Care Settings; CDC C. difficile infection control recommendationsReport a problem with this question

14. 14. In what order does the CDC recommend putting on personal protective equipment before entering an isolation room?

    • A.Gown, then mask or respirator, then goggles or face shield, then gloves✓ Answer
    • B.Gloves first, then gown, then mask or respirator, then goggles or face shield
    • C.Mask or respirator, then gloves, then gown, then goggles or face shield
    • D.Goggles or face shield, then gown, then gloves, then mask or respirator

    Donning works from the body outward and ends with gloves so that the glove cuffs are pulled over the gown sleeves and seal the wrists, which is impossible if gloves go on first. Hand hygiene is performed before the first item is put on.

    Source: CDC Sequence for Donning Personal Protective EquipmentReport a problem with this question

15. 15. Which statement correctly describes CDC-recommended removal of personal protective equipment after a draw in an isolation room?

    • A.Gloves come off first because they are the most contaminated item✓ Answer
    • B.Goggles come off first because they are the least contaminated
    • C.The gown comes off first because it covers the largest body surface
    • D.The mask comes off first so the phlebotomist can breathe freely

    Removal runs from most contaminated to least, so gloves come off first and the mask or respirator comes off last and outside the room, since airborne organisms may still be present at the doorway. Hand hygiene follows immediately after the last item is removed.

    Source: CDC Sequence for Removing Personal Protective EquipmentReport a problem with this question

16. 16. What is the defining principle of Standard Precautions as issued by the CDC?

    • A.All patients are treated as infectious regardless of their diagnosis✓ Answer
    • B.All patients with a known infection are placed in a private room
    • C.Only patients with a confirmed bloodborne diagnosis are isolated
    • D.Only patients flagged as high risk on the requisition need gloves

    Standard Precautions apply the same barrier practices to every patient because infectious status is often unknown at the time of the draw, which is exactly why the older risk-based approach failed. Transmission-based precautions are then layered on top for specific known or suspected organisms.

    Source: CDC Guideline for Isolation Precautions (2007), Standard PrecautionsReport a problem with this question

17. 17. A patient on airborne precautions for pulmonary tuberculosis needs a blood draw. What protection does the phlebotomist need?

    • A.A face shield over a surgical mask, worn only while the patient is coughing
    • B.A gown and gloves put on at the doorway, with dedicated equipment left in the room
    • C.A fit-tested N95 or higher respirator, with the door of the negative-pressure room kept closed✓ Answer
    • D.A surgical mask worn within three feet of the patient, with the door kept closed

    Airborne pathogens travel on droplet nuclei that stay suspended and pass around a surgical mask, so entry requires a fit-tested N95 or higher respirator and an airborne infection isolation room kept under negative pressure with the door closed. Gowns and face shields address contact and splash routes, not inhalation.

    Source: CDC Guideline for Isolation Precautions (2007), airborne precautions; OSHA 29 CFR 1910.134 respirator fit testingReport a problem with this question

18. 18. A patient is on contact precautions for methicillin-resistant Staphylococcus aureus. What does the phlebotomist do before entering the room?

    • A.Put on gloves alone and wipe the tourniquet after the draw
    • B.Put on a fit-tested respirator and close the door on entry
    • C.Put on a gown and gloves and use equipment kept in the room✓ Answer
    • D.Put on a surgical mask and remain three feet from the patient

    Contact precautions target organisms spread by touching the patient or contaminated surfaces, so a gown and gloves go on before entry and equipment such as the tourniquet stays dedicated to that room. A mask protects against droplet spread and does nothing about the hands and sleeves that actually carry these organisms.

    Source: CDC Guideline for Isolation Precautions (2007), contact precautionsReport a problem with this question

19. 19. A facility spill procedure calls for a freshly prepared 1:10 sodium hypochlorite solution. How is that solution prepared?

    • A.1 part household bleach added to 10 parts water
    • B.1 part bleach added to 9 parts isopropyl alcohol
    • C.1 part household bleach added to 9 parts water✓ Answer
    • D.10 parts household bleach added to 1 part water

    A 1:10 dilution means one total part of bleach in ten total parts of finished solution, that is 1 part bleach plus 9 parts water. Hypochlorite loses activity on standing and is inactivated by mixing with alcohol or other chemicals, so it is prepared fresh with water only.

    Source: OSHA 29 CFR 1910.1030(d)(4)(ii); CDC guidance on decontamination of blood spillsReport a problem with this question

20. 20. How should a labeled tube of blood be packaged for transport to an off-site reference laboratory?

    • A.In a rigid sharps container, with the requisition in the same pocket
    • B.In an unlabeled zip bag, with the requisition folded around the tube
    • C.In a leakproof biohazard bag, with the requisition in the outer sleeve✓ Answer
    • D.In a padded envelope, with the requisition taped to the tube itself

    Specimens leaving the facility must go in a closable, leakproof secondary container that is labeled or color-coded for biohazard, and the requisition rides in a separate outer sleeve so paperwork stays readable if the tube leaks. A sharps container is for waste, and an unlabeled bag gives the courier no warning of the hazard.

    Source: OSHA 29 CFR 1910.1030(d)(2)(xiii) and (g)(1)(i)Report a problem with this question

21. 21. The morning quality control on a CLIA-waived glucose meter falls outside the manufacturer's acceptable range. What must the operator do?

    • A.Run one patient sample first to see whether the meter reads it plausibly
    • B.Adjust the control value to the acceptable range and continue testing patients
    • C.Report patient results and note that the control was slightly out of range
    • D.Hold all patient results, document the failure, troubleshoot and repeat the control✓ Answer

    An out-of-range control means the measuring system is not demonstrably accurate, so no patient result from that run may be reported until the cause is found and a control is back in range; common causes are expired or improperly stored reagent, temperature excursion, and operator technique. Reporting anyway or altering the control record falsifies the quality record.

    Source: CLIA quality system requirements, 42 CFR 493.1256; manufacturer instructions for waived testsReport a problem with this question

22. 22. A result on a repeat specimen triggers a delta check because it differs sharply from the same patient's previous result. What does a delta check primarily warn of?

    • A.A patient who has been fasting for longer than was ordered
    • B.A reagent lot that expired sometime after the run was finished
    • C.An instrument that has reached its next scheduled maintenance
    • D.A possible specimen mix-up or mislabeling during collection✓ Answer

    A delta check compares a patient's current result with their own prior result, so a physiologically implausible swing points first to a pre-analytical identity error such as drawing the wrong patient, mislabeling, or an aliquot placed in the wrong tube. The specimen and the patient identification are verified before the result is released.

    Source: Clinical laboratory quality assessment: delta check review of patient results (CLIA 42 CFR 493.1289; CLSI QMS quality management)Report a problem with this question

Concept-focused practice questions based on CLSI GP41 (venous blood collection), the CLSI order of draw, and the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030). Not affiliated with the NHA, ASCP, or CLSI, and not medical advice. Facility protocols and current CLSI standards take precedence — always follow your employer's procedures. About the CPT exam →