22 Safety & Infection Control Practice Questions & Answers

1. 1. A phlebotomist is asked where the facility's written plan for eliminating or minimizing employee exposure to blood is documented. Which OSHA standard requires that plan?

   • A.21 CFR 606, the FDA blood products regulations
   • B.29 CFR 1910.1200, the Hazard Communication Standard
   • C.29 CFR 1910.1030, the Bloodborne Pathogens Standard✓ Answer
   • D.42 CFR 493, the CLIA regulations

   The Bloodborne Pathogens Standard, 29 CFR 1910.1030(c)(1), requires every employer with employees who have occupational exposure to establish a written Exposure Control Plan designed to eliminate or minimize that exposure. The Hazard Communication Standard covers hazardous chemicals and SDSs, CLIA regulates laboratory testing, and 21 CFR 606 governs blood product manufacturing — none of them requires an Exposure Control Plan.

   Source: OSHA 29 CFR 1910.1030(c)(1) — Exposure Control PlanReport a problem with this question

2. 2. During an internal audit, a supervisor must show how the Exposure Control Plan is maintained. Which statement reflects OSHA's requirement?

   • A.It only needs updating after an employee reports an exposure incident
   • B.It is optional for facilities with fewer than ten employees
   • C.It must be rewritten from scratch every three years by an outside consultant
   • D.It must be reviewed and updated at least annually and whenever new tasks or procedures affect exposure, and must document annual consideration of safer medical devices✓ Answer

   OSHA requires the plan be reviewed and updated at least annually and whenever new or modified tasks and procedures affect occupational exposure; the annual review must document consideration and implementation of appropriate commercially available safer medical devices. There is no small-employer exemption and no outside-consultant or three-year rewrite requirement.

   Source: OSHA 29 CFR 1910.1030(c)(1)(iv) — annual review and updateReport a problem with this question

3. 3. A hospital is choosing a new safety-engineered butterfly device. Under the Bloodborne Pathogens Standard, whose input must the employer solicit and document?

   • A.The state health department's licensing board
   • B.The facility's legal counsel and risk manager only
   • C.Non-managerial employees who are potentially exposed and who use the devices in patient care✓ Answer
   • D.The device manufacturer's sales representatives

   OSHA requires the employer to solicit input from non-managerial employees responsible for direct patient care who are potentially exposed, because frontline users are best positioned to judge whether a control actually works in practice; that input must be documented in the Exposure Control Plan. Attorneys, vendors, and licensing boards do not satisfy this requirement.

   Source: OSHA 29 CFR 1910.1030(c)(1)(v) — solicitation of employee inputReport a problem with this question

4. 4. An employee resigns after eight years. How long must the employer keep her OSHA bloodborne pathogens medical record and her annual training records?

   • A.Both for the duration of employment plus 30 years
   • B.Medical records for the duration of employment plus 30 years; training records for 3 years✓ Answer
   • C.Both for 3 years from the date of separation
   • D.Medical records for 5 years; training records for 1 year

   Employee exposure-related medical records must be kept for the duration of employment plus 30 years in accordance with 29 CFR 1910.1020, because occupational disease from bloodborne infection can appear decades later; training records need only be kept for 3 years from the date the training occurred. Mixing the two retention periods is one of the most commonly missed points on the exam.

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

5. 5. A phlebotomist has just removed her gloves after a draw and is about to chart at the nurses' station. What does OSHA require her to do?

   • A.Wash her hands only if she can see blood on them
   • B.Apply lotion first, then wash at the end of her shift
   • C.Skip hand hygiene because the gloves protected her hands
   • D.Wash her hands immediately, or as soon as feasible, after glove removal✓ Answer

   OSHA requires handwashing immediately or as soon as feasible after removal of gloves or other PPE, because gloves can have unnoticed micro-perforations and hands are readily contaminated during removal. Gloves are never a substitute for hand hygiene, and visible soiling is not the trigger.

   Source: OSHA 29 CFR 1910.1030(d)(2)(v)-(vi) — handwashing after glove removalReport a problem with this question

6. 6. A phlebotomist is preparing to enter the room of a patient on contact and droplet precautions. In what order should she put on her PPE?

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

   The CDC donning sequence is gown, mask or respirator, goggles or face shield, then gloves. Gloves go on last so they can be pulled over the gown cuffs, sealing the wrist — the area most likely to be splashed during a venipuncture.

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

7. 7. After finishing a draw in an isolation room, a phlebotomist begins removing PPE. Which item should be removed FIRST, and which LAST?

   • A.Gloves first; the mask or respirator last, after leaving the room✓ Answer
   • B.Gown first; the gloves last, inside the room
   • C.Mask first; the gown last, at the doorway
   • D.Goggles first; the gloves last, at the nurses' station

   The CDC doffing sequence is gloves, goggles or face shield, gown, then mask or respirator, followed immediately by hand hygiene. Gloves come off first because their exterior is the most heavily contaminated surface, and the mask or respirator comes off last and outside the room so the airway stays protected until the worker has left the contaminated space.

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

8. 8. A patient in contact precautions for Clostridioides difficile has just been drawn. What is the correct hand hygiene action?

   • A.Wash with soap and water, because alcohol-based hand rub does not kill C. difficile spores✓ Answer
   • B.Use alcohol-based hand rub, which is faster and equally effective
   • C.Use alcohol rub first, then apply a moisturizer
   • D.No hand hygiene is needed if gloves were worn the entire time

   Alcohol-based hand rub has no sporicidal activity, so it cannot inactivate C. difficile spores; the physical friction and rinsing of soap-and-water handwashing mechanically removes them from the skin. Soap and water is likewise required when hands are visibly soiled with blood or body fluids and after caring for patients with norovirus.

   Source: CDC Guideline for Hand Hygiene in Healthcare Settings — soap and water for spore-forming organismsReport a problem with this question

9. 9. A phlebotomist is assigned to collect blood from a patient with active pulmonary tuberculosis. What precautions are required?

   • A.Standard precautions alone, since blood is not the route of TB transmission
   • B.Airborne precautions: a fit-tested N95 or higher respirator and a negative-pressure isolation room✓ Answer
   • C.Droplet precautions: a surgical mask worn on entry to the room
   • D.Contact precautions: gown and gloves only

   Tuberculosis spreads by droplet nuclei small enough to remain suspended and travel on air currents, so a surgical mask is inadequate; a fit-tested NIOSH-approved N95 or higher respirator plus an Airborne Infection Isolation Room with negative pressure and 6-12 air changes per hour is required. Measles and varicella also require airborne precautions, and all transmission-based precautions are used in addition to standard precautions.

   Source: CDC 2007 Guideline for Isolation Precautions — Airborne PrecautionsReport a problem with this question

10. 10. A phlebotomist has just withdrawn a needle from a patient's vein. What must she do FIRST with the device?

    • A.Recap the needle with two hands to protect coworkers
    • B.Activate the safety feature immediately at the point of use, before leaving the patient✓ Answer
    • C.Remove the needle from the tube holder and discard them separately
    • D.Carry the needle to the sharps container in the hallway and activate it there

    The safety feature must be activated immediately upon withdrawal, at the bedside, because an unshielded contaminated needle carried across a room is the classic setting for a needlestick. The needle and tube holder are then discarded as a single unit, and two-handed recapping is prohibited.

    Source: OSHA 29 CFR 1910.1030(d)(2)(i) and (d)(2)(vii) — engineering and work practice controlsReport a problem with this question

11. 11. A student states that OSHA forbids recapping a contaminated needle under any circumstance. How should the instructor correct this?

    • A.Recapping is prohibited unless no alternative is feasible or the procedure requires it, and then only by a one-handed scoop or a mechanical device✓ Answer
    • B.The student is correct; recapping is banned with no exception whatsoever
    • C.Recapping is always allowed as long as the phlebotomist is careful
    • D.Recapping is permitted whenever the sharps container is more than ten feet away

    OSHA's prohibition on bending, shearing, breaking, or recapping contaminated needles carries a narrow exception: when the employer can demonstrate no alternative is feasible or that the specific medical procedure requires recapping, it must be done with a one-handed technique or a mechanical recapping device so the free hand is never in the needle's path. An absolute 'never under any circumstance' statement misstates the rule.

    Source: OSHA 29 CFR 1910.1030(d)(2)(vii)(A) — recapping exceptionReport a problem with this question

12. 12. Which set of characteristics correctly describes a compliant sharps container?

    • A.Closable, puncture-resistant, leakproof on sides and bottom, labeled or color-coded, and kept upright near the point of use✓ Answer
    • B.Reusable plastic that staff empty into the biohazard bag at the end of each shift
    • C.Clear glass so the fill level is visible, kept on the floor out of the walkway
    • D.Cardboard with a snap lid, stored in a locked closet down the hall

    OSHA requires sharps containers to be closable, puncture-resistant, leakproof on sides and bottom, labeled or color-coded, maintained upright, located as close as feasible to the area of use, and replaced routinely without being allowed to overfill. Manually emptying a container or reaching into it defeats the barrier that protects the worker's hands.

    Source: OSHA 29 CFR 1910.1030(d)(4)(iii)(A) — sharps container requirementsReport a problem with this question

13. 13. A sharps container in the draw station is filling up. When should it be replaced?

    • A.At the end of every shift regardless of contents
    • B.When it is completely full and the lid can no longer close
    • C.Routinely, before it becomes overfilled — typically at the manufacturer's or FDA-recommended fill line✓ Answer
    • D.Only when items begin protruding from the opening

    OSHA's regulatory text requires only that containers be replaced routinely and not be allowed to overfill; the familiar fill-line or roughly three-quarters-full guidance comes from FDA and manufacturer instructions for use. Waiting until sharps protrude or the lid will not close creates exactly the puncture hazard the container is meant to prevent.

    Source: OSHA 29 CFR 1910.1030(d)(4)(iii)(A)(2) — routine replacement, not overfilled; FDA sharps disposal guidanceReport a problem with this question

14. 14. A phlebotomist sustains a needlestick from a used needle. What is her FIRST action?

    • A.Wash the site with soap and water, then report to her supervisor immediately✓ Answer
    • B.Pour undiluted bleach over the wound to disinfect it
    • C.Squeeze the puncture site hard to force out contaminated blood
    • D.Finish the patient's draw, then report at the end of the shift

    Immediate washing with soap and water removes contaminated material from the wound, and prompt reporting starts the clock on post-exposure evaluation and prophylaxis, which is most effective when begun early. Squeezing or milking the site can increase tissue trauma, and caustic agents such as bleach damage tissue without proven benefit.

    Source: OSHA 29 CFR 1910.1030(f)(3) — post-exposure evaluation and follow-up; CDC exposure management guidanceReport a problem with this question

15. 15. Following an exposure incident, when must the exposed employee receive the healthcare professional's written opinion?

    • A.Within 15 days of the completion of the evaluation✓ Answer
    • B.Within 30 days of the employee's written request
    • C.Only if the source patient tests positive
    • D.Within 90 days of the exposure incident

    OSHA requires the employer to provide the employee a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation, so the employee learns promptly whether further follow-up is needed. The 90-day figure belongs to a different rule: a baseline blood sample must be preserved for 90 days if the employee consents to collection but declines HIV testing at that time.

    Source: OSHA 29 CFR 1910.1030(f)(5) — healthcare professional's written opinionReport a problem with this question

16. 16. A newly hired phlebotomist asks about the hepatitis B vaccine. Which statement is accurate under the OSHA standard?

    • A.He must undergo antibody prescreening before the employer will offer the series
    • B.It must be offered free of charge within 10 working days of initial assignment, after training; declining requires signing a declination form, and he may still request it later at no cost✓ Answer
    • C.He must pay half the cost unless he has already had an exposure incident
    • D.Declining the vaccine permanently waives his right to receive it

    OSHA requires the hepatitis B vaccination series be made available at no cost within 10 working days of initial assignment and after the employee has received bloodborne pathogens training, so the decision is informed. Prescreening may not be required as a condition of receiving the vaccine, and an employee who signs the Appendix A declination retains the right to request and receive the vaccine later at no cost.

    Source: OSHA 29 CFR 1910.1030(f)(1)-(f)(2) — hepatitis B vaccinationReport a problem with this question

17. 17. A phlebotomist must clean a large blood spill on the floor of the draw room. After donning gloves and other PPE, what is the correct sequence?

    • A.Pour disinfectant directly on the blood first, then wipe it all up at once
    • B.Absorb and remove the bulk of the spill, clean the surface, then apply an EPA-registered disinfectant or 1:10 bleach for the required contact time✓ Answer
    • C.Wipe the blood up with dry paper towels and consider the area safe
    • D.Spray the area with an air freshener, then mop with detergent only

    Cleaning must precede disinfection because sodium hypochlorite is substantially inactivated by organic material such as blood and protein, so disinfectant poured onto an uncleaned spill is neutralized before it can kill pathogens. Removing bulk material first, then applying an EPA-registered tuberculocidal disinfectant or a 1:10 bleach dilution for roughly 10 minutes of contact time, ensures actual decontamination.

    Source: OSHA 29 CFR 1910.1030(d)(4)(ii) — decontamination of work surfaces; CDC disinfection guidanceReport a problem with this question

18. 18. A protocol calls for a 1:10 dilution of household bleach for blood spill decontamination. What does this produce?

    • A.A 10% bleach solution, roughly 0.5% sodium hypochlorite, prepared fresh daily✓ Answer
    • B.Undiluted bleach at full 5.25% strength
    • C.A 10% sodium hypochlorite solution that stays effective for one month
    • D.A 1% bleach solution suitable only for countertops

    One part household bleach (about 5.25% sodium hypochlorite) in ten parts total volume yields a 10% bleach solution, which is approximately 0.5% sodium hypochlorite — not 10% hypochlorite, a very common misreading. Hypochlorite degrades on exposure to light and air, so working dilutions are prepared fresh daily to guarantee potency.

    Source: CDC Guideline for Disinfection and Sterilization — hypochlorite dilutions for blood spillsReport a problem with this question

19. 19. A tube of blood breaks in the centrifuge, leaving contaminated glass fragments in the bowl. How should the phlebotomist remove them?

    • A.With mechanical means such as tongs, forceps, or a brush and dustpan — never by hand✓ Answer
    • B.By pouring disinfectant in and swirling the fragments into the drain
    • C.With double-gloved hands, picking up the largest pieces first
    • D.By vacuuming the bowl with a standard office vacuum cleaner

    OSHA prohibits picking up contaminated broken glassware directly with the hands, even gloved, because glass readily penetrates gloves and turns a cleanup into a percutaneous exposure; tongs, forceps, or a brush and dustpan must be used and the fragments placed in a sharps container. Double gloving does not make hand retrieval acceptable.

    Source: OSHA 29 CFR 1910.1030(d)(4)(ii)(D) — contaminated broken glasswareReport a problem with this question

20. 20. A phlebotomist inserts the needle and the patient reports sudden sharp, shooting pain radiating down the forearm. What should she do NEXT?

    • A.Tell the patient the pain is normal and complete all ordered tubes
    • B.Loosen the tourniquet and finish filling the remaining tubes quickly
    • C.Discontinue the draw immediately and remove the needle, then notify the supervisor and document the event✓ Answer
    • D.Reposition the needle slightly deeper and continue the collection

    Sudden sharp, shooting, radiating, electric, or burning pain signals probable nerve involvement, and continuing or repositioning the needle risks permanent nerve injury and legal liability. The correct response is to withdraw the needle at once, apply pressure, notify the supervisor or provider, and complete an incident report.

    Source: CLSI GP41 — venipuncture complications; discontinue on nerve painReport a problem with this question

21. 21. An outpatient becomes pale, diaphoretic, and says she feels faint midway through a venipuncture. What should the phlebotomist do FIRST?

    • A.Leave to get help while the patient remains in the chair with the needle in place
    • B.Finish the remaining tubes quickly so the draw does not have to be repeated
    • C.Hold an ammonia inhalant under her nose to revive her
    • D.Release the tourniquet and remove the needle immediately, then lower her head and stay with her✓ Answer

    Syncope is the most common venipuncture complication, and the needle must come out first so the patient cannot be injured by it if she loses consciousness and moves. The phlebotomist must never leave the patient unattended, ammonia inhalants are no longer recommended because they can trigger adverse respiratory reactions, and the patient should be observed until fully recovered before standing or driving.

    Source: CLSI GP41 — management of syncope during venipunctureReport a problem with this question

22. 22. A phlebotomist runs the daily control on a CLIA-waived glucose meter and the result falls outside the acceptable range. What should she do?

    • A.Report the patient results but add a comment noting the control failure
    • B.Withhold patient results, troubleshoot and repeat the control, and notify the supervisor✓ Answer
    • C.Average the failed control with yesterday's passing control and proceed
    • D.Run the patient sample twice and report the value closer to normal

    An out-of-range control means the test system is not demonstrably accurate at that moment, so any patient result generated on it is unreliable and must not be released; the correct response is to troubleshoot (check reagent expiration, storage, technique, and instrument function), repeat the control, and notify the supervisor. Averaging, commenting, or cherry-picking results does not restore analytic validity and violates CLIA quality-control requirements.

    Source: CLIA 42 CFR 493.1256 — control procedures; results not reported when QC failsReport 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 →