TEST BANK DIAGNOSTIC MICROBIOLOGY 4TH EDITION

TEST BANK DIAGNOSTIC MICROBIOLOGY 4TH EDITION TEXTBOOK OF DIAGNOSTIC MICROBIOLOGY 4TH EDITION TEST BANK Mahon: Textbook of Diagnostic Microbiology, 4th Edition Chapter 04: Control of Microorganisms Test Bank MULTIPLE CHOICE 1. The chemical or physical method that destroys all forms of life is called: a. Sterilization Textbook of Diagnostic Microbiology 4th Edition Test Bank b. Disinfection c. Bacteriostatic d. Bactericidal ANS: A Sterilization is the destruction of all forms of life, including bacterial spores. Disinfection is a process that eliminates a defined scope of microorganisms, including, in some cases, spores. Bacteriostatic inhibits the growth of microorganisms. Bactericidal kills bacteria. REF: page 62 OBJ: Level 1 – Recall 2. Organisms that are the most resistant to heat, chemicals, and radiation are: a. Parasites b. Prions c. Bacteria d. Viruses ANS: B Prions are naked pieces of protein, so they are harder to kill than any other organism. Viruses usually contain a nucleic acid, and all the mentioned forms of killing can effectively disrupt their nucleic acid. Bacteria and parasites are complete organisms that are killed by disinfection and sterilization, even in the spore and cyst stages. REF: page 63 OBJ: Level 1 – Recall 3. After using the phone, the laboratory tech sprayed the receiver with a chemical spray. This process will kill a defined scope of microorganisms. What is this process called? a. Sterilization b. Bacteriostatic c. Disinfection d. Bactericidal ANS: C Sterilization kills all organisms and spores at a site. Bacteriostatic and bactericidal are adjectives that describe the particular action of chemical agents: to inhibit bacterial growth or kill bacteria. Disinfection kills a defined scope of microorganisms. REF: page 62 OBJ: Level 2 – Interpretation 4. Before performing a phlebotomy, the phlebotomist will clean the area on a patient’s arm with a substance before inserting the needle. This substance is called a(n): a. Disinfectant b. Sterilizer c. Antiseptic d. Bactericidal ANS: C A disinfectant is a chemical agent used to kill microorganisms on an inanimate object. To sterilize is to kill all life; skin will still have organisms growing after wiping. Bactericidal is the process of killing bacteria. An antiseptic is a substance applied to the skin for the purpose of eliminating or reducing the number of bacteria present. REF: page 62 OBJ: Level 2 – Interpretation 5. All the following factors play a significant role in the selection and implementation of the appropriate method of disinfection EXCEPT: a. Temperature b. Contact time c. Biofilms d. Humidity ANS: D Temperature, contact time, and biofilms all play a role in selection and implementation of the appropriate method of disinfection. Humidity is not important when attempting to disinfect or kill organisms. REF: pages 62-63 OBJ: Level 1 – Recall 6. When eliminating organisms from inanimate objects, higher numbers of organisms require longer exposure times because: a. All disinfecting agents are not alike and some require shorter times. b. The chemical composition of the disinfecting agent varies. c. Disinfecting agents containing carbon tetrachloride require longer times to act. d. It takes longer to eliminate 99% of microorganisms. ANS: D When there are higher numbers of microorganisms, it takes longer to kill 99% of microorganisms present. Although disinfectants are different, it still takes longer to kill more organisms. The chemical composition of a disinfecting agent may affect the time required to kill microorganisms, but microbial load is a determining factor. REF: page 63 OBJ: Level 1 – Recall 7. When using disinfectants, it is important to follow the manufacturer’s instructions for diluting the product because if it is not diluted properly: a. There may not be enough free chemicals to kill the organisms. b. You would be wasting money by using too much disinfectant. c. The resulting solution would not kill mycobacteria. d. The resulting solution would not kill parasites. ANS: A The manufacturer tests disinfectants at a particular dilution, and this is the dilution needed for optimum performance of the disinfectant. If the manufacturer’s instructions are not followed, optimum effectiveness cannot be guaranteed. REF: page 63 OBJ: Level 1 – Recall 8. If this is present on a surface to be disinfected, it can shield microorganisms from the disinfectant or inactivate the disinfectant. What is this substance? a. Bleach (sodium hypochlorite) b. Organic material c. Hydrochloric acid d. Water ANS: B Bleach, hydrochloric acid, and water can counteract another disinfectant, but they cannot shield microorganisms from a disinfectant. Organic matter (e.g., blood, pus) can keep the disinfectant from reaching and killing the microorganism. REF: page 64 OBJ: Level 1 – Recall 9. When killing microorganisms, you must take all the following into consideration EXCEPT: a. A type of microorganism b. Temperature c. Humidity d. Bioburden ANS: C The type of microorganism (bacteria, mycobacteria, parasite, etc.), the temperature, and the bioburden (the number of bacteria) must be taken into consideration when decided how to best kill microorganisms. The humidity plays no role in the killing of microorganisms. REF: page 64 OBJ: Level 1 – Recall 10. Disinfectants are usually used at this temperature. a. 50° to 100° C b. 0° to 10° C c. 25° to 50° C d. 20° to 22° C ANS: D Disinfectants are usually used at room temperature (20° to 22° C). Too high or too low a temperature can actually inactivate a disinfectant. REF: page 64 OBJ: Level 1 – Recall 11. Using two disinfectants to clean an area may actually do more harm than good. Why? a. Two disinfectants may increase the amount of corrosion that occurs on a surface. b. Two disinfectants may cause an adverse chemical reaction where a poisonous gas may be released. c. When used together, two disinfectants may combine to sterilize a site instead of just disinfecting it. d. Two disinfectants may inactivate one another’s activity against microorganisms. ANS: D In many disinfectants, free ions are responsible for the killing activity of the solution. If two solutions are mixed and one binds the free ions in the other solution, the microbial killing ability terminates. REF: page 64 OBJ: Level 2 – Interpretation 12. Pasteurization achieves _____. a. Disinfection b. Sterilization c. Asepsis d. Filtration ANS: A Pasteurization kills foodborne pathogens, but not microbial spores present in a liquid. Because sterilization is killing of all microorganisms plus spores and cysts, pasteurization only disinfects. Asepsis describes no bacteria present. Filtration describes another method of disinfection where microorganisms are removed from a liquid by a physical device—a filter. REF: page 65 OBJ: Level 1 – Recall 13. Autoclaves use this method to sterilize inanimate objects. a. Dry heat b. Heat under steam pressure c. Microwaves d. Infrared light rays ANS: B Putting steam under 1 atmosphere of pressure achieves a temperature of 121° C. This temperature and this pressure will kill all microorganisms except prions. Dry heat will not kill spores or cysts. Microwaves and infrared light rays are not used for sterilization or disinfecting objects. REF: page 65 OBJ: Level 1 – Recall 14. Chemosterilizers exert their killing effect through all the following mechanisms EXCEPT: a. Denaturation of cellular proteins b. Damage of RNA and DNA c. Inactivating enzyme substrates d. Reactions with components of the cytoplasmic membrane ANS: C If a chemical can denature proteins that are used by the cell, damage RNA or DNA, or react with components of the cell membrane, they can damage the cell. Inactivating an enzyme substrate may or may not have an effect on cellular function. REF: page 66 OBJ: Level 1 – Recall 15. Alcohols use this mechanism to inactivate microorganisms. a. Denature proteins b. Destroy DNA c. Denature RNA d. Inhibit cell wall synthesis ANS: A Alcohols do not have the capability to destroy DNA, denature RNA, or inhibit cell wall synthesis. Instead, they disrupt the tertiary and quaternary structure of the cell wall proteins to destroy microorganisms. REF: page 67 OBJ: Level 1 – Recall 16. A laboratory technician is working with tissue infected with Mycobacterium tuberculosis that has been preserved in formalin for a couple years. After dissecting the tissue, how should the worker sterilize the work area? a. Wipe down the work area with a 37% formalin solution. b. Wipe down the work area with a 10% bleach solution. c. Wipe down the work area with a 50% alcohol solution. d. Use formaldehyde gas to clean the area. ANS: B 1. tuberculosis can survive for years in formalized specimens. A powerful sterilizer is needed to sterilize this area, and that is 10% bleach. Alcohol is not a sterilizer but rather an antiseptic. Formaldehyde gas is used to disinfect biosafety hoods, but it is not a sterilizer. REF: pages 67-68 OBJ: Level 3 – Synthesis 17. The tech needs to sterilize a piece of equipment that cannot be autoclaved or gas sterilized because the equipment contains lenses, metal, and rubber components. What solution should be used to sterilize this piece of equipment? a. 10% bleach b. 37% formalin c. Glutaraldehyde d. 90% alcohol ANS: C 10% bleach cannot be used because it is a corrosive and can corrode metal; 37% formalin cannot be used because it is a carcinogen, and the Occupational Safety and Health Administration (OSHA) does not recommend it for routine sterilizing or disinfecting; 90% alcohol can be corrosive, but it is also inactivated with any organic material that may be present on the instrument. Glutaraldehyde is the sterilant of choice because it is not inactivated by organic material, and it can kill both microbes and spores, depending on contact time. REF: page 67 OBJ: Level 1 – Recall 18. For the most effective microbial killing, all iodophors must be properly diluted because: a. They stain the skin if too concentrated. b. This decreases contact time for adequate killing. c. There must be enough free iodine to kill the microorganisms. d. This increases contact time for adequate killing. ANS: C When iodophors are used as skin preparations, contact time is essential for killing microorganisms. Contact time does not depend on dilution. Iodophors are considered nonstaining. The reason for diluting iodophors properly is that the dilution ratio is important to ensure there is enough free iodine to kill microorganisms. REF: page 68 OBJ: Level 1 – Recall 19. Even though hypochlorites are inexpensive and have a broad range of microbes that they kill, they are not used as sterilants because of: a. The corrosive nature of the compound b. The activation required by organic matter c. Short exposure time for sporicidal action d. Long exposure time for sporicidal action ANS: D Hypochlorites require a long exposure time to kill spores, and they are inactivated by organic material present on an object. They are not used as a disinfectant because they are corrosive. REF: page 68 OBJ: Level 1 – Recall 20. Disinfectants containing heavy metal compounds have been replaced as disinfectants, except for _____, which is still used as a prophylactic treatment in newborns to prevent gonococcal conjunctivitis. a. Silver nitrate b. Copper sulfate c. Ammonium nitrate d. Mercuric chloride ANS: A Mercuric chloride is a preservative used in parasitology. Copper sulfate is used to estimate the amount of hemoglobin in a drop of blood. Ammonium nitrate is used as a component of gunpowder. Silver nitrate is indeed used to swab the eyes of newborns to protect them from gonococcal conjunctivitis. REF: page 69 OBJ: Level 1 – Recall 21. Many materials in hospitals that must be sterilized cannot withstand steam sterilization. Gas sterilization is used instead, using this gas. a. Nitrous oxide b. Oxygen c. Ethylene oxide d. Carbon dioxide ANS: C Nitrous oxide, oxygen, and carbon dioxide are all gases, but they do not kill microbes or their spores. Ethylene oxide is usually mixed with nitrogen or carbon dioxide before use because it is explosive in its pure form. It is used in hospitals and in the manufacturing industry for sterilizing thermoplastic products. REF: page 70 OBJ: Level 1 – Recall 22. Why should health care workers wash their hands after coming into contact with a patient? a. To reduce the amount of red blood cells transmitted from one patient to the next b. To reduce the occurrence of hemolytic transfusion reactions c. To reduce the need for antiseptics and disinfectants d. To reduce the spread of pathogenic bacteria from one individual to another ANS: D Any pathogenic bacteria present on the hands of one individual will be passed on to the next individual unless the hands are washed to remove the pathogens. Hands visibly contaminated with red blood cells are always washed after becoming soiled. Hemolytic transfusion reactions are caused by the intravenous administration of red blood cells. Antiseptics and disinfectants will always be needed to cleanse skin and inanimate objects to free them of pathogenic bacteria. REF: page 71 OBJ: Level 1 – Recall 23. High-level disinfectants are active against all the following EXCEPT: a. Parasites b. Spores c. Fungi d. Tubercle bacilli ANS: A High-level disinfectants are active against vegetative cells, tubercle bacilli, spores, fungi, and viruses. These disinfectants have no activity against parasites. REF: page 64 OBJ: Level 1 – Recall 24. This agency regulates the use, sale, and distribution of antimicrobial pesticide products for certain inanimate, hard, nonporous surfaces, or incorporated into substances under the pesticide law. a. Antimicrobial Division of Environmental Protection Agency (EPA) b. Centers for Disease Control and Prevention (CDC) c. U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID) d. U.S. Food and Drug Administration (FDA) ANS: A The CDC acts as a clearinghouse for information of medically important bacteria and houses one of two Biosafety Level 4 laboratories. The other Biosafety Level 4 laboratory is found at the Army infectious disease research facility, USAMRIID. The FDA regulates substances that are put into the body. The Antimicrobial Division of the EPA regulates the use of antimicrobials on inanimate, nonporous surfaces. REF: page 70 OBJ: Level 1 – Recall 25. The disinfectant label should indicate several highlighted points important in selecting the appropriate agents for designated use, including all the following EXCEPT: a. Level of biocidal action b. Alcohol content c. The nature of microbial contamination d. Structure and design of an item to be disinfected ANS: B The label of a disinfectant should include the structure and design of an item, active ingredient of chemical, pH, hardness of water, exposure time, extent of precleaning, biocidal action, nature of microbial contamination, requirements of chemical agents, kill time, composition of items to be disinfected, and method of application. REF: pages 70-71 OBJ: Level 2 – Interpretation 26. These two alcohols are effective in killing hepatitis B virus (HBV). a. 50% isopropyl and 50% butanol b. 95% propanol and 70% ethanol c. 70% isopropyl and 95% ethanol d. 70% pentanol and 70% isopropyl ANS: C The only two alcohols used in U.S. hospitals that kill HBV are 70% isopropyl and 95% ethanol. REF: page 67 OBJ: Level 1 – Recall 27. This chemical is a saturated 5-carbon dialdehyde that has broad-spectrum activity, rapid killing action, and remains active in the presence of organic matter. a. Formalin b. Formaldehyde c. Haloaldehyde d. Glutaraldehyde ANS: D Formalin is designated as a carcinogen by the Occupational Safety and Health Administration (OSHA), and worker exposure limits have been set. These adverse effects limit its usefulness. Formaldehyde is a gas that is usually known as formalin. Haloaldehyde is not used as a disinfectant. Glutaraldehyde is a good killing agent because it has broad-spectrum activity, rapid killing action, remains active in the presence of organic matter, and can be used on sensitive equipment. REF: page 67 OBJ: Level 2 – Interpretation 28. These disinfectants are cationic, surface-activated agents that work by reducing the surface tension of molecules in a liquid, resulting in the disruption of the cellular membrane of microbes. a. Quaternary ammonium compounds b. Heavy metals c. Chlorines d. Iodophors ANS: A Heavy metals are bacteriostatic. The mechanism by which chlorines kill microorganisms is the oxidative effects of hypochlorous acid. Iodophors kill through the action of periodic acid. Quaternary ammonium compounds are disinfectants that are cationic, surface-activated agents that disrupt the cellular membrane of microbes. REF: page 68 OBJ: Level 2 – Interpretation 29. This organization regulates chemical skin antiseptics. a. Environmental Protection Agency (EPA) b. Food and Drug Administration (FDA) c. Centers for Disease Control and Prevention (CDC) d. National Institutes of Health (NIH) ANS: B The Antimicrobial Division of the EPA regulates disinfectants. The CDC is the nation’s clearinghouse on infectious diseases. The NIH is a conglomerate of special federal agencies that award research grants to further knowledge in a particular area. The FDA regulates chemical skin antiseptics. REF: page 70 OBJ: Level 1 – Recall 30. The main goal of handwashing is to: a. Sterilize a person’s hand. b. Increase the risk of passing on pathogens. c. Eliminate transient florae. d. Disinfect a person’s hands. ANS: C A person’s hands are never sterile; therefore, the best handwashing scenario would be to cleanse the hands of transient florae. Sterilizing someone’s hands would also strip the hands of essential oils that would contribute to drying and cracking of the skin. Washing would eliminate most pathogens, thereby decreasing, not increasing, a person’s ability to transmit pathogens. Disinfection occurs when microorganisms are killed on inanimate objects. REF: page 71 OBJ: Level 1 – Recall 31. Routine handwashing in health care settings mandates washing at all the following times EXCEPT: a. In high-risk areas such as ICU and burn units b. On entering protective isolation units c. Before and after routine patient contact d. When gloves become soiled during a procedure or dressing change on the same patient. ANS: D Soiled gloves are changed during a procedure or dressing change on a single patient, but the hands are not washed until contact with that patient terminates. REF: page 71 OBJ: Level 1 – Recall 32. The purpose of surgical hand scrubs and waterless hand rubs is to: a. Eliminate the transient florae and most of the resident florae on the skin. b. Remove all physical dirt and some residential florae. c. Remove all resident florae. d. Remove all transient florae. ANS: A Surgical scrubs try to eliminate as much bacteria from the surgeon’s hand as possible. In case the surgeon’s glove is torn or punctured, very little bacteria will enter the surgical wound. So as much transient and resident florae as possible must be removed by the surgical hand scrubs and waterless hand rubs. REF: page 72 OBJ: Level 1 – Recall 33. The three types of alcohol used as an effective skin antiseptic include all the following EXCEPT: a. 60% to 95% ethanol b. Butyl alcohol c. 50% to 91.3% isopropyl alcohol d. n-Propyl alcohol ANS: B Federal regulations identify 60% to 95% ethanol and 50% to 91.3% isopropyl for use in the United States as an effective skin antiseptic. Europeans use n-propyl alcohol as a skin antiseptic. Butyl alcohol is not approved for use as a skin antiseptic. REF: page 72 OBJ: Level 1 – Recall 34. The most concentrated forms of ethanol and isopropyl alcohol are less bactericidal than the diluted forms of these alcohols. Why? a. No free radicals are present in solution to kill the bacteria. b. Only the dilutions can dissolve the lipopolysaccharide cell walls. c. Proteins are not denatured readily in the absence of water. d. Killing bacteria also requires the solution be heated, and it is difficult to heat concentrated alcohols because they flammable. ANS: C Alcohols do not contain free radicals; their bacteriocidal action is based on denaturing proteins. Concentrated alcohols can dissolve the lipopolysaccharide cell wall, but killing the bacteria still relies on protein denaturation. These solutions do not have to be heated to exert their bactericidal effect. REF: page 67 OBJ: Level 2 – Interpretation 35. The most common iodophor used in the United States for preoperative skin preparation is: a. Calcium iodophor b. 95% ethanol and iodine c. Tincture of iodine d. Povidone iodine ANS: D Povidone iodine contains a low amount of free molecular iodine, reducing toxic effects, staining, and irritation. It also provides slow and continuous release of iodine. Tincture of iodine is not used as frequently. Ca iodophor and 95% ethanol and iodine are not used for preoperative surgical skin preparation. REF: page 68 OBJ: Level 1 – Recall 36. This topical antiseptic disrupts the microbial cell membrane and precipitates the cellular contents. a. Chlorhexidine gluconate b. Povidone-iodine c. 95% ethanol d. 60% isopropyl alcohol ANS: A Povidone iodine uses hypoiodonic acid and free iodine to disrupt the cell and eventually kill it. The bactericidal mechanism for alcohols is denaturing proteins. The bactericidal mechanism for chlorhexidine gluconate is to disrupt the microbial cell membrane and precipitate the cellular contents. REF: page 69 OBJ: Level 2 – Interpretation 37. This compound is a diphenyl ether, and it exerts its bactericidal effects by disrupting the cell wall. It has good activity against gram-positive cocci, but poor activity against fungi. What is its name? a. 95% ethanol b. Triclosan c. Chlorhexidine gluconate d. Povidone iodine ANS: B 95% Ethanol denatures the cellular proteins. Chlorhexidine gluconate disrupts the cellular membrane and spills the cell’s contents. Povidone iodine kills the bacteria with free iodine and hypoiodonic acid. Finally, Triclosan is a diphenyl ether, and it exerts its bactericidal effects by disrupting the cell wall. REF: page 69 OBJ: Level 2 – Interpretation 38. Laboratory safety includes all the following areas EXCEPT: a. Radioactivity b. Chemical c. Isolation d. Fire ANS: C Isolation safety and precautions are usually practiced in conjunction with the patient on the floor or outpatient setting. In the laboratory, there are few patients, so safety focuses on areas like radioactivity, chemical safety, and fire safety. REF: page 75 OBJ: Level 1 – Recall 39. Why is laboratory-acquired infection an obvious hazard for personnel working in a microbiology lab? a. Microbiology personnel do not always adhere to safety practices. b. Safety practices are not applicable for the microbiology laboratory. c. In-service education is not provided for microbiology staff. d. Personnel deal with a variety of infections agents: viral, fungal, parasitic, and bacterial. ANS: D All specimens handled by laboratory techs are considered to be potentially infectious. Therefore if a person is careless, a laboratory-acquired infection can occur. Microbiology personnel should follow safety procedures for their own safety. Safety procedures do apply to the microbiology laboratory, and training is provided to each employee. REF: page 77 OBJ: Level 1 – Recall 40. The comprehensive safety program for the microbiology laboratory needs to fulfill all the following provision EXCEPT: a. It is specific to the hospital and does not need to conform to state, local, and federal regulations. b. It must address biologic hazards. c. It must teach correct techniques for lifting and moving heavy objects and patients (where applicable). d. It must describe the safe handling, storage, and disposal of chemicals. ANS: A The safety program must comply with federal and state regulations, hospital procedures, and good laboratory practice. It needs to address all safety hazards (fire, chemical, radiologic, and biologic) and be uniformly applied. Procedures need to be written, and employees need to take responsibility for keeping their workplace safe. REF: page 75 OBJ: Level 1 – Recall 41. Processing of patient specimens and handling of actively growing cultures of microorganisms puts an employee at risk of potential contact with the infectious agent through all the following routes EXCEPT: a. Mucous membranes b. Blood splashed onto intact skin c. Inhalation of aerosols d. Accidental ingestion ANS: B When working with specimens and culture plates, there is little chance of contracting an infection if blood is splashed onto intact skin. Infection—through the mucous membranes by rubbing eyes with contaminated hands, from inhaling aerosolized microorganisms, or by accidental ingestion—is possible when handling specimens and actively growing culture plates. REF: page 78 OBJ: Level 1 – Recall 42. All of the following organisms can typically cause infection from aerosolization of specimens EXCEPT: a. Mycobacterium tuberculosis b. Brucella spp. c. Staphylococcus aureus d. Francisella tularensis ANS: C Many reported cases of laboratory workers being infected with M. tuberculosis after being exposed to aerosols when processing sputum specimens fill the literature. Brucella and F. tularensis are very infectious organisms and several cases a year are reported of laboratory workers who contract the disease after processing culture specimens. Cases of S. aureus infection of laboratory workers occur often, but not usually through aerosol inhalation. REF: page 76 OBJ: Level 1 – Recall 43. The most common route of infection of laboratory workers with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is: a. Mucous membranes b. Inhalation c. Ingestion d. Needlestick ANS: D HBV and HIV are blood-borne pathogens that are transmitted through exposure to blood and body fluids. Although infection through the mucous membranes has occurred, the most common route of infection of health care workers is through needlesticks where the organisms are introduced into the bloodstream. REF: page 76 OBJ: Level 1 – Recall 44. What protective measures can a laboratory worker take when working with actively growing cultures to ensure that they do not become infected? a. Ensure that fungal cultures are sealed and worked in a biosafety cabinet. b. Wash their hands at the end of their shift. c. Handle specimens routinely, using extra care for HIV and HBV cultures. d. Take off bandages on fingers when reading plates. ANS: A Fungal cultures produce many infectious spores that can disseminate rapidly via the ventilation system if a plate is opened on the bench in a laboratory. These cultures should always be handled in a biosafety cabinet. Bench techs should wash their hands frequently to ensure the number of pathogenic microorganisms on their hands is always low. All specimens should be handled as though they are HBV and HIV positive—with extreme care. Cuts on the hand should always be covered by finger cots or gloves. REF: page 78 OBJ: Level 1 – Recall 45. The laboratory exposure control plan should contain all the following EXCEPT: a. Engineer and work practice controls b. Review of control plan every 5 years c. Methods of compliance for Standard Precautions d. Guidelines for handling and disposal of regulated waste ANS: B The exposure control plan is mandated by the Occupational Safety and Health Administration (OSHA) to protect workers against blood-borne pathogens. This plan must be reviewed and updated annually. It must contain a determination of tasks and procedures that may result in an occupational hazard, a plan to investigate all exposure incidents and a plan to prevent these from reoccurring, methods of compliance for Standard Precautions, engineering and work practice controls, personal protective equipment, guidelines for ensuring that the work site is maintained in a clean and sanitary manner, guidelines for handling and disposal of regulated waste, and a training program for all employees (OSHA Bloodborne Standards). REF: page 75 OBJ: Level 1 – Recall 46. Universal/Standard Precautions require that: a. Only some body fluids be considered infectious and capable of transmitting disease b. Body fluids with visible blood be treated as noninfectious c. Blood and body fluids from all patients be considered infectious and capable of transmitting disease d. Urine and feces be considered noninfectious ANS: C Anything that comes from a patient is capable of transmitting disease. Blood and all body fluids, including secretions and excretions, except sweat, regardless of whether visible blood is present, are considered infectious. REF: pages 75-76 OBJ: Level 1 – Recall 47. Engineering controls and work practice controls to ensure Standard Precautions are followed include all the following EXCEPT: a. Eyewash stations b. The use of safety needles c. Plastic shield barriers d. Fire blankets ANS: D The Occupational Safety and Health Administration (OSHA) defines engineering controls as controls that isolate or remove the hazard from the workplace. Some examples of engineering controls are the use of closed tube sampling by laboratory equipment, the use of safety needles and single-use holders, eyewash stations, emergency showers, and plastic shield barriers. Ideally laboratories should have negative air pressure, access to the laboratory should be limited, and there should be a plan to prevent insect infestation. REF: page 76 OBJ: Level 1 – Recall 48. Standard Precautions do not address the following: a. Handwashing b. Gloves c. Lab coats d. Respirators ANS: D To ensure the guidelines required in Standard Precautions are followed within the laboratory, engineering controls and work practice controls are instituted, and employers must provide personal protective equipment. Respirators are not included in the items addressed by Standard Precautions because they are used in a Biosafety Level 3 laboratory. REF: page 75 OBJ: Level 1 – Recall 49. Work Practice Controls consist of all of the following EXCEPT: a. Ensuring written procedures are in place for a task b. Altering the manner in which a task is performed to reduce exposure to infectious agents c. Allowing workers to eat at the bench if it gets busy and they don’t have time to take a lunch break d. Reviewing the procedure manual annually ANS: C Work practice controls consist of altering the manner in which a task is performed to reduce the likelihood of exposure to infectious agents. This is accomplished by no mouth pipetting; no eating, drinking, or applying cosmetics in the laboratory; disinfecting workstations at the end of each shift and after any spill of infectious material; no recapping or breaking of contaminated needles; disposal of needles in an appropriate puncture-resistant container; performing procedures in a manner to minimize splashing and the generation of air droplets; placing specimens for transport in wellconstructed containers with secure lids to prevent leakage of infectious materials; and frequent handwashing. REF: page 76 OBJ: Level 1 – Recall 50. All of the following are examples of personal protective equipment (PPE) EXCEPT: a. Gloves b. Lab coats c. Safety glasses d. Prescription glasses ANS: D PPE must be protective and appropriate. Blood and body fluids must not be able to penetrate the PPE material. Prescription glasses are not considered PPE because splashes of blood and body fluids can get to the eye by coming in around the sides, top, and bottom of the glasses. Safety glasses form a barrier where body fluids cannot come in around the sides, top, or bottom. REF: page 76 OBJ: Level 1 – Recall 51. Technicians are doing the morning chemistry run. Once they load the specimens onto the instrument, they remove their gloves to do paperwork in a clean area of the laboratory. What should the technicians do after removing their gloves? a. Reposition the tubes in the racks. b. Take a break and eat a snack. c. Call any critical values. d. Wash their hands. ANS: D As soon as the gloves come off, the technicians must wash their hands to ensure that all potential pathogens are removed before the technicians touch inanimate objects in the clean area of the laboratory. REF: page 76 OBJ: Level 3 – Synthesis 52. The Biosafety Levels were categorized using all the following criteria EXCEPT: a. The bacterial load necessary to cause infection b. The organism’s ability to cause serious illness c. The organism’s mode of transmission d. Whether there is treatment available for an infection ANS: A The four Biosafety Levels were derived from categories of etiologic agents. These categories include the organism’s ability to cause serious illness, the organism’s mode of transmission, whether there is treatment available for infection, and whether there are any preventive measures, such as vaccines. Bacterial load was not a criterion. REF: page 78 OBJ: Level 1 – Recall 53. A Biosafety Level 1 (BSL-1) level of containment is used for organisms that: a. Cause 90% mortality of infected people b. Are well classified and not known to cause disease in healthy people c. Cause 90% morbidity of infected people d. Can be transmitted through aerosols ANS: B This is the lowest level of biosafety. These organisms pose a minimal threat to laboratory personnel and the environment. Lab work can be conducted on open bench tops. Employees should be trained in laboratory procedures and supervised by a scientist with training in microbiology. REF: page 79 OBJ: Level 1 – Recall 54. A Biosafety Level 2 (BSL-2) level of containment is used for organisms that: a. Can cause a catastrophe if released b. Usually cause 90% mortality in the population c. Create a moderate potential hazard for employees and the environment d. Do not cause significant harm to employees and the environment ANS: C These organisms pose a moderate hazard. Guidelines for laboratories that handle these agents include having a biosafety cabinet, limiting access to the laboratory when cultures are out, having employees receive immunizations for contact with possible pathogens, having an up-to-date biosafety manual, wearing personal protective equipment (PPE), and restricting use of sharp items to times when no alternative equipment can be used. REF: page 80 OBJ: Level 1 – Recall 55. Because Biosafety Level 3 (BSL-3) organisms have the potential for aerosol transmission, and diseases with these agents may have serious lethal consequences, all of the following guidelines apply to BSL-3 labs EXCEPT: a. BSL-3 labs should be separated from other parts of the building by an anteroom. b. BSL-3 labs should have restricted access with logbook documentation of personnel entering and exiting lab. c. BSL-3 labs should have solid ceiling and floor seams, and any seams must be sealed. d. BSL-3 labs should have positive air pressure. ANS: D BSL-3 labs must follow BSL-2 safety guidelines and must also have a Class II or III biologic safety cabinet; must ensure that employees wear appropriate personal protective equipment (PPE); should be separated from the other parts of the building by an anteroom; should have negative air pressure and the air from inside the lab should be directed outside without recirculation; should hav