Free IBSC DICO-C practice questions with answers

Twenty-five original, source-verified IBSC DICO-C questions with full answers and rationale below, free to read, no account required. A new set every day.

1. Question 1

   A home-care supervisor asks the officer whether staff must wear gowns and gloves routinely for every visit to a patient colonised with a resistant organism. What does the guideline say?

   • Neither gowns nor gloves are needed in home care in any circumstance.
   • Gowns and gloves are needed only if the patient has been hospitalised in the previous month.
   • Routine gowns and gloves are recommended for every such visit, because the guideline extends its acute-care contact precautions to home care wherever the patient is known to be colonised.
   • No recommendation is made for routine gloves and gowns in ambulatory or home care; Standard Precautions apply, with gowns and gloves for uncontrolled secretions, pressure ulcers, draining wounds, stool incontinence and ostomy appliances.Correct

   Why: The guideline separates the settings deliberately. For home care it directs following Standard Precautions, making sure gowns and gloves are used for contact with uncontrolled secretions, pressure ulcers, draining wounds, stool incontinence and ostomy tubes and bags, and it then records expressly that no recommendation is made for routine use of gloves, gowns or both to prevent transmission in ambulatory or home care settings, marking it an unresolved issue. It also asks that reusable equipment be limited in the home and left there until discharge where possible. A blanket requirement and a blanket exclusion both go beyond the guideline, and a recent-hospitalisation trigger appears nowhere in it. Primary reference: Management of Multidrug-Resistant Organisms in Healthcare Settings (CDC/HICPAC, 2006), V.A.5.e and V.A.5.f, p. 40.

2. Question 2

   Which statement best reflects the guidance on choosing between hepatitis A vaccine and immune globulin for an exposed, unvaccinated healthy adult under forty?

   • Either may be used, and the choice should be made by the receiving facility's pharmacy on the basis of stock and cost rather than by the exposed person's age provided the product chosen is administered within two weeks of the exposure.
   • Immune globulin is preferred because it acts immediately, and vaccine is reserved for people who need long-term protection as well.
   • Both should be given simultaneously at separate sites as the standard approach for any occupational exposure.
   • One dose of vaccine is recommended and immune globulin is not, since vaccine induces active immunity and offers longer protection, easier administration and greater availability.Correct

   Why: For a healthy person aged twelve months to forty years, the recommendation is one dose of vaccine with no immune globulin, and the guidance sets out the advantages of vaccine over immune globulin as induction of active immunity, longer duration of protection, ease of administration, and greater acceptability and availability. Immune globulin is added for older adults on the provider's risk assessment and for people who are immunocompromised or have chronic liver disease, so preferring it as a default reverses the recommendation. Giving both routinely is not the standard approach. Leaving the choice to pharmacy stock ignores the age and health-status structure the recommendation is built on. Primary reference: Prevention of Hepatitis A Virus Infection in the United States, MMWR Recomm Rep 2020;69(RR-5), Table 4, p. 19, and ACIP Recommendations for Postexposure Prophylaxis, p. 21. Cross-reference: Prevention of Hepatitis A Virus Infection in the United States, MMWR Recomm Rep 2020;69(RR-5), Appendix B, p. 36.

3. Question 3

   Designated officers in a neighbouring State tell you the federal emergency-responder notification part does not operate there. Under what circumstance is that correct?

   • Where the State has an OSHA-approved occupational safety and health plan
   • Where the State's chief executive officer has certified that State law is substantially consistentCorrect
   • Where the State's public health officer has declined to designate officers
   • Where the State has enacted its own statute governing notification after an emergency responder's exposure

   Why: The part does not apply in a State if the chief executive officer of the State certifies to the Secretary that the law of the State is substantially consistent with it. The certifying official is the State's chief executive, not its health officer or its legislature, and the test is substantial consistency rather than the mere existence of a State statute on the subject. This is one of the few places where a designated officer must know the answer for a particular State before advising on procedure, and it is a question for State counsel. An approved State occupational safety and health plan concerns OSHA standards and has no bearing on this part. Primary reference: 42 U.S.C. § 300ff-140, Applicability of part.

4. Question 4

   Personnel born before 1957 have no evidence of immunity to measles, mumps or rubella. What does the 2025 adult schedule direct for them?

   • No action; birth before 1957 is conclusive evidence of immunity for all personnel.
   • Consider a two-dose series at least four weeks apart for measles or mumps protection, or one dose for rubella protection.Correct
   • A three-dose series, because their birth cohort has waning immunity.
   • Serologic testing, with vaccination only if a titre is negative, since screening is the cost-effective approach in a cohort whose members are very likely to have been infected in childhood.

   Why: The schedule treats personnel separately from other adults on this point. For personnel born before 1957 with no evidence of immunity, it says to consider a two-dose series at least four weeks apart for protection against measles or mumps, or one dose for protection against rubella; for personnel born in 1957 or later with no evidence of immunity it directs completing that two-dose series or at least one dose for rubella. So birth before 1957 is presumptive evidence rather than a conclusion beyond reconsideration, and the number of doses tracks which disease is in question. A three-dose series is the outbreak provision for mumps rather than a cohort rule, and requiring a negative titre before vaccinating runs against the recommendation that prevaccination screening is not necessary. Primary reference: Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025, Notes - Measles, mumps, and rubella vaccination, Health care personnel, p. 7. Cross-reference: MMWR Recomm Rep 2011;60(RR-7), Measles - Recommendations, p. 13.

5. Question 5

   An employee with two documented doses of measles-mumps-rubella vaccine is serologically tested by an outside clinic and returns an equivocal measles titre. The employee asks for a third dose. What does the officer decide?

   • Do not give a further dose; documented age-appropriate vaccination supersedes the results of subsequent serologic testing.Correct
   • Administer a third dose and repeat the titre one to two months later, following the same revaccinate-and-retest sequence the recommendation sets out for a hepatitis B vaccine nonresponse.
   • Exclude the employee from patient care until a protective titre is documented.
   • Administer a third dose, because the titre is the more direct measure of protection.

   Why: The recommendation addresses this exact situation. Where a person with two documented doses is tested serologically and found to have negative or equivocal measles titre results, it is not recommended that the person receive an additional dose, and such persons should be considered to have presumptive evidence of measles immunity, because documented age-appropriate vaccination supersedes the results of subsequent serologic testing. It also says serologic testing is not recommended for personnel who already have two documented doses, which is why the outside test should not have been done. Giving a third dose, or excluding the employee, both treat the titre as the governing measure when the recommendation says the vaccination record is. Primary reference: MMWR Recomm Rep 2011;60(RR-7), Measles - Prevaccination Testing, p. 13.

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7. Question 6

   When should the officer schedule the agency's influenza vaccination clinics, on the reasoning ACIP gives?

   • In July, so that the whole workforce is covered before any activity begins.
   • Ideally during September or October for most persons needing one dose, continuing after October and throughout the season while viruses circulate.Correct
   • Only in December, at the usual peak of activity.
   • Twice each season, since a booster dose is recommended for personnel whose exposure continues through the winter and whose vaccine-induced immunity may wane before the peak of activity.

   Why: ACIP's timing guidance weighs the unpredictability of the season against possible waning of vaccine-induced immunity over its course, and concludes that for most persons needing only one dose vaccination should ideally be offered during September or October, while continuing after October and throughout the season as long as influenza viruses are circulating and unexpired vaccine is available. It also asks providers to use routine visits and hospitalisations to avoid missed opportunities, and states that revaccination of persons already fully vaccinated for the season is not recommended. A July clinic risks waning before the peak, a December-only clinic misses early activity, and a second dose for personnel is expressly not recommended. Primary reference: MMWR Recomm Rep 2024;73(RR-5), Timing of Vaccination, p. 4.

8. Question 7

   A dispatcher who is not covered by the bloodborne pathogens standard is injured helping a bleeding colleague in the car park. She reports it to you. What does OSHA say about follow-up in a case like this?

   • The standard's follow-up requirements apply, because the injury happened on the employer's premises and arose out of employment.
   • The employer must refer her to the public health department, which handles exposures outside the standard's scope.
   • OSHA strongly encourages employers to offer the follow-up procedures, although the standard does not require it for employees outside its scope.Correct
   • The employer must first determine whether her job description includes any reasonably anticipated contact with blood, and if it does not, no report is made and the matter is closed.

   Why: OSHA's guidance notes that employees outside the scope of the standard may still experience an exposure incident unrelated to their job duties, gives voluntary Good Samaritan assistance to an injured co-worker as the example, and strongly encourages employers to offer such employees the follow-up procedures in the paragraph. Asserting that the standard applies because the injury happened at work misstates the scope test, which turns on reasonably anticipated occupational exposure rather than location. There is no referral route to a health department for these cases. Closing the matter after finding the job description does not include blood contact is technically defensible but is not what OSHA encourages, and it leaves an exposed worker unmanaged. Primary reference: OSHA Directive CPL 02-02-069, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, paragraph (f)(3) note, printed p. 54. Cross-reference: 29 CFR 1910.1030(f)(1)(i) (7-1-24 edition), Hepatitis B vaccination and post-exposure evaluation and follow-up, printed p. 303.

9. Question 8

   A crew transported a patient with confirmed West Nile virus encephalitis and now asks the officer what precautions were required. What is the answer?

   • Droplet Precautions for the duration of illness.
   • Contact Precautions until the patient is no longer viraemic.
   • Airborne Precautions, because aerosol transmission of West Nile virus has been documented and the guideline assigns an airborne category wherever an aerosol route has been shown to exist.
   • Standard Precautions; these viruses are not transmitted person to person except rarely by transfusion and, for West Nile virus, by transplant, breast milk or transplacentally.Correct

   Why: The isolation guideline groups the arthropod-borne viral encephalitides, West Nile virus among them, and assigns Standard Precautions, noting they are not transmitted from person to person except rarely by transfusion and, for West Nile virus, by organ transplant, breast milk or transplacentally, with advice about screens and repellents in endemic areas. Aerosol infection has occurred in laboratory workers handling the virus, which is a different exposure setting from caring for a patient, and reading that across to patient transport would impose airborne precautions the guideline does not support. Primary reference: 2007 Guideline for Isolation Precautions (CDC/HICPAC), Appendix A - Arthropod-borne viral encephalitides and viral fevers, p. 97. Cross-reference: West Nile Virus in the United States (CDC), Human Surveillance - Routes of Transmission, p. 12.

10. Question 9

    A shift supervisor asks for a copy of the sharps injury log to see who has been injured. What does the law require of the log's contents in this respect?

    • The log may name the injured employee, but only managers may see it
    • The log must name the injured employee so that the follow-up can later be audited
    • The log is a public record and must be posted where employees can read it
    • It must be maintained so as to protect the injured employee's confidentialityCorrect

    Why: Both the Act and the standard require that the information in the sharps injury log be recorded and maintained in such a manner as to protect the confidentiality of the injured employee. That is why the three required entries identify the device, the work area and the mechanism rather than the person. Naming the employee, whether for management review or for audit, cuts across the requirement; follow-up is audited from the confidential medical record, access to which is separately controlled. The log is not a posted record, although records required by the standard must be made available to the Assistant Secretary and the Director for examination and copying. Primary reference: 29 CFR 1910.1030(h)(5)(i) (7-1-24 edition), Sharps injury log, printed p. 307. Cross-reference: Needlestick Safety and Prevention Act, Pub. L. 106-430, 114 Stat. 1903, § 3(5).

11. Question 10

    A new board member asks why medical waste treatment standards differ from one State to the next when there was once a Federal tracking programme. What is the accurate answer?

    • The Federal programme was repealed when the bloodborne pathogens standard took effect in 1992.
    • The Federal programme was a demonstration in a listed set of States that expired twenty-four months after its implementing regulations took effect.Correct
    • The Federal programme remains in force but is enforced only on petition by a State governor.
    • The Federal programme was consolidated into the transport regulations and now applies nationwide. Tracking of medical waste therefore continues under the packaging and marking rules that govern shipments in commerce.

    Why: The statute establishing the medical waste tracking programme covered New York, New Jersey, Connecticut, the States contiguous to the Great Lakes and any State admitted by petition, with an opt-out for certain governors, and it provided that the demonstration programme would expire twenty-four months after the effective date of its implementing regulations. That expiry, not a repeal and not a consolidation, is the documentary reason medical waste treatment is now largely a State matter, which in turn is why the blueprint lists medical waste among State laws. The transport rule governs packaging and marking in commerce and did not absorb the tracking programme. Primary reference: 42 U.S.C. 6992(d), Expiration of demonstration program, printed p. 6982.

12. Question 11

    An employee reports that a patient's blood splashed onto the back of her forearm. The officer inspects the site and finds the skin there entirely intact, with no cut, abrasion or rash. Applying the regulatory definition, how does the officer classify the event?

    • An exposure incident, because blood reached the employee's body.
    • An exposure incident, because forearm skin is not a mucous membrane.
    • Not an exposure incident; contact confined to intact skin falls outside the definition, and the officer records the report and the finding.Correct
    • Not an exposure incident, but only because the employee washed and flushed the area within five minutes, which the standard treats as interrupting the contact before it becomes an exposure.

    Why: The definition of an exposure incident is closed: eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials arising from duties. Blood on genuinely intact skin is none of those. The officer still documents the report and the skin finding, because that finding is the whole basis of the classification and a later reviewer will need it. The two options treating it as an exposure misread the definition, and washing the area is sound practice but does not change what the event was. Primary reference: 29 CFR 1910.1030(b) (7-1-24 edition), Definitions - Exposure Incident, printed p. 295. Cross-reference: MMWR Recomm Rep 2001;50(RR-11), Definition of Health-Care Personnel and Exposure, p. 3.

13. Question 12

    A facility informs the officer that a transported patient has mumps. For how long should the patient have been isolated, and under what category?

    • Droplet Precautions until five days after the onset of parotid swelling.Correct
    • Contact Precautions for the duration of illness.
    • Droplet Precautions until nine days after the onset of parotid swelling, as originally recommended.
    • Airborne Precautions until nine days after the onset of parotid swelling.

    Why: The isolation guideline assigns mumps to Droplet plus Standard Precautions, and its October 2017 update records that the advisory committee voted to change the isolation recommendation from nine days to five days after onset of swelling. The nine-day figure is the superseded one and the guideline marks the note carrying it as superseded, so an officer working from an older summary will hold a patient or restrict staff longer than current guidance requires. Mumps is not an airborne-category disease and negative-pressure rooms are not required for it. Primary reference: 2007 Guideline for Isolation Precautions (CDC/HICPAC), Appendix A - Mumps, p. 107. Cross-reference: MMWR Recomm Rep 2011;60(RR-7), Mumps - Controlling Mumps Outbreaks in Health-Care Settings, p. 16.

14. Question 13

    A product's label claims it reduces bacteria on food contact surfaces but does not claim to destroy them. Under the antimicrobial data requirements, which term describes it?

    • A sanitizer, because it reduces the bacterial population without eliminating itCorrect
    • A disinfectant, because it acts on bacteria in the inanimate environment
    • A tuberculocide, because food contact surfaces require that level of claim
    • A sterilant, because a food contact surface must be free of all forms of microbial life

    Why: The antimicrobial data requirements define the terms that a label claim invokes. A sanitizer reduces the bacteria population in the inanimate environment by significant numbers but does not destroy or eliminate all bacteria, and sanitizers meeting public health ordinances are generally used on food contact surfaces as sanitizing rinses. A disinfectant destroys or irreversibly inactivates bacteria, fungi and viruses in the inanimate environment. A sterilant destroys or eliminates all forms of microbial life including bacterial spores. A tuberculocide destroys or irreversibly inactivates tubercle bacilli. The claim on the label, not the surface, determines which definition applies, so a product used on a food contact surface is not thereby a sterilant. Primary reference: 40 CFR 158.2203 (7-1-24 edition), Definitions, printed p. 185.

15. Question 14

    Two crew members transported a patient later confirmed to have varicella. One shared the patient compartment for the twenty-minute transport; the other passed the stretcher in the ambulance bay for a few seconds. How should the officer treat the two contacts?

    • Both are substantial exposures, because the organism is airborne and any shared air space is sufficient regardless of the length of the contact.
    • Neither is a substantial exposure unless the patient's lesions were uncovered and the responder touched them directly during the encounter.
    • Only the second is a substantial exposure, because transient contact in an enclosed bay concentrates airborne particles more than a moving vehicle does.
    • Only the first is a substantial exposure; brief contact of the kind described for the second is less likely to result in transmission.Correct

    Why: Substantial exposure for hospital contacts consists of sharing the same room with an infectious patient or direct face-to-face contact, the contact should not be transient, and brief contacts of the kind involving staff who pass through are described as less likely than more prolonged contacts to result in transmission. Treating any shared air space as substantial would put the whole shift under surveillance and devalue the assessment. Requiring direct contact with lesions is too narrow for an organism transmitted through the air. The suggestion that a brief bay encounter is worse than a shared transport reverses the guidance. The officer's task is to draw a defensible contact list, and duration of contact is the criterion offered. Primary reference: Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices, MMWR Recomm Rep 2007;56(RR-4), Types of Exposure, pp. 30-31. Cross-reference: Prevention of Varicella, MMWR Recomm Rep 2007;56(RR-4), Indications for the Use of VZIG for Postexposure Prophylaxis, p. 30.

16. Question 15

    An employee who has sustained a needlestick from an HIV-positive source demands to know the numerical risk before agreeing to anything. Which figures does the officer give from the federal guidance?

    • About 0.3% after a percutaneous exposure and about 0.09% after a mucous membrane exposure.Correct
    • About 0.03% after a percutaneous exposure and about 0.009% after a mucous membrane exposure.
    • About 1.8% after a percutaneous exposure and about 0.3% after a mucous membrane exposure.
    • About 3% after a percutaneous exposure and about 1% after a mucous membrane exposure.

    Why: Prospective studies put the average risk of HIV transmission at approximately 0.3% after percutaneous exposure to HIV-infected blood and approximately 0.09% after a mucous membrane exposure. The officer who carries these numbers can answer the question without guessing, which matters because an employee who is given an inflated figure may accept prophylaxis he does not need and one given a deflated figure may refuse what he does. The 1.8% figure belongs to hepatitis C, not HIV, and is a common confusion in exactly this conversation. Primary reference: MMWR Recomm Rep 2001;50(RR-11), Risk for Occupational Transmission of HIV, p. 7.

17. Question 16

    Your organisation's written protective equipment hazard assessment covers eye protection, gloves and protective clothing. A consultant says the same assessment discharges the respirator selection duty. Why is that wrong?

    • Because respirator selection is delegated entirely to the manufacturer.
    • Because respirators are not personal protective equipment.
    • Because the hazard assessment must be repeated annually while respirator selection is a one-time decision. The two therefore cannot share a single document.
    • Because the hazard assessment and training paragraphs of the protective equipment section do not apply to the respiratory protection standard.Correct

    Why: The protective equipment section states that its hazard assessment and training paragraphs apply only to the listed equipment sections and do not apply to respiratory protection or to personal fall protection. The respirator duties live in their own standard: identify and evaluate the respiratory hazard, estimate exposures, select a certified respirator and record all of that in the written programme. Respirators plainly are protective equipment, and selection is the employer's duty rather than the manufacturer's. The annual point is a distractor; it is fit testing and training, not the hazard assessment, that recur annually. Primary reference: 29 CFR 1910.132(g) (7-1-24 edition), printed p. 422.

18. Question 17

    Your sharps injury log records the date, the injured employee's name and the department. An inspector raises two problems. What are they?

    • The log omits the type and brand of device and the explanation of how the incident occurred, and it identifies the injured employee.Correct
    • The log omits the source individual's status and the employee's vaccination history. Both are needed to judge whether the device or the exposure was the more important factor.
    • The log omits the supervisor's signature and the corrective action taken.
    • The log omits the cost of the follow-up and the days of work lost.

    Why: The standard prescribes three minimum contents for the sharps injury log: the type and brand of device involved, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. It also requires the information to be recorded and maintained so as to protect the confidentiality of the injured employee, which is why a name is a defect rather than an addition. More information may be included so long as confidentiality holds. The other options describe useful management data but none is a required element, and none is what an inspector reads the log for: the directive explains that the log exists to evaluate the devices in use and to identify problem areas quickly. Primary reference: 29 CFR 1910.1030(h)(5)(i) (7-1-24 edition), Sharps injury log, printed p. 307.

19. Question 18

    A hospital's ward clerk realises on 1 June that she has been mailing exposure follow-up letters to a wrong address for weeks, but does not tell anyone until 20 June. When was the breach discovered for notification purposes?

    • 20 June, when the entity's privacy officer was told
    • 1 June, because the clerk is a workforce member and her knowledge is the entity'sCorrect
    • 1 June only if the clerk was authorised to handle the information
    • The date the compliance committee formally determines that a breach occurred

    Why: A breach is treated as discovered on the first day it is known to the covered entity, or would have been known by exercising reasonable diligence, and the entity is deemed to have knowledge if the breach is known, or would have been known by reasonable diligence, to any person other than the person committing the breach who is a workforce member or agent. Here the clerk is not the person who committed the breach in the sense of a deliberate wrongful act; she is a workforce member who learned of it, so the clock started when she did. Internal escalation and formal committee findings do not reset the clock, which is why an infection control officer's reporting procedures need to move upward the same day. Building the reporting obligation into training is the practical answer. Primary reference: 45 CFR 164.404(a)(2) (10-1-24 edition), Breaches treated as discovered, printed p. 682.

20. Question 19

    Personnel on maintenance haemodialysis are employed in the agency's clinical division. What does the recommendation direct for their hepatitis B serologic follow-up?

    • Exclusion from duties involving reasonably anticipated exposure to blood.
    • Nothing beyond the ordinary post-vaccination test after the primary series.
    • Annual surface antibody testing, with a booster dose of vaccine when the level declines below 10 mIU/mL.Correct
    • Testing every five years, with a full repeat three-dose series if the level has declined below the protective concentration since the last measurement was recorded.

    Why: This is the express exception to the rule that immunocompetent responders need no further periodic testing. Personnel receiving haemodialysis should be provided annual surface antibody testing and should be administered a booster dose of vaccine when levels decline below 10 mIU/mL. The recommendation also notes that for other immunocompromised personnel, such as those with HIV infection, transplant recipients and those receiving chemotherapy, the frequency of post-vaccination testing and the need for booster doses have not been determined, which is an honest gap the officer should not fill by analogy. Doing nothing, stretching the interval to five years, and excluding the employee from duty are all departures from the recommendation. Primary reference: MMWR Recomm Rep 2011;60(RR-7), Hepatitis B - HCP and Trainees at Additional Risk, p. 8.

21. Question 20

    For the purposes of a contact investigation, how is the infectious period of a smear-positive index patient defined?

    • It runs from the date of the first positive smear until the patient completes two weeks of treatment, whichever is later, and covers every shift on which any crew transported that patient once the health department has confirmed the dates.
    • It runs for the twenty-one days before diagnosis, matching the longest documented incubation interval for the organism.
    • It begins three months before the first positive smear or the symptom onset date, whichever is earlier, and ends when airborne precautions are applied or at the first of consistently negative smears, whichever is earlier.Correct
    • It cannot be defined programmatically and must be set case by case by the treating physician after reviewing the culture results.

    Why: For programmatic purposes with a smear-positive patient, the infectious period begins three months before the collection date of the first positive smear or the symptom onset date, whichever is earlier, and ends on the date the patient is placed under airborne precautions or the date of collection of the first of consistently negative smears, whichever is earlier. Tying the end to two weeks of treatment is not the definition used. Twenty-one days confuses the infectious period with an incubation interval. Saying it cannot be defined programmatically is exactly wrong: the definition exists so that a contact list can be drawn up, which is what the officer needs in order to know which crews to include. Primary reference: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, MMWR Recomm Rep 2005;54(RR-17), Initiating a Contact Investigation, printed p. 35. Cross-reference: Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel, MMWR 2019;68(19):439, Postexposure screening and testing, printed p. 441.

22. Question 21

    An exposed employee consents to baseline blood collection but declines testing for human immunodeficiency virus at that time. What must the employer's post-exposure arrangements provide?

    • That the sample be tested anyway and the result withheld from the employee until she consents. Testing without disclosure preserves the baseline while respecting the employee's decision.
    • That the employee be required to decide within seventy-two hours.
    • That the sample be discarded and a fresh specimen drawn if the employee changes her mind.
    • That the baseline sample be preserved for at least ninety days, and tested as soon as feasible if she elects testing within that period.Correct

    Why: The standard allows the employee to consent to collection without consenting to testing, and then requires the sample to be preserved for at least ninety days, with testing as soon as feasible if the employee elects it within that period. The directive explains the purpose: the window removes the pressure of an immediate decision and thereby encourages employees to consent to collection at the time of exposure, which is what makes a true baseline possible. It also tells compliance officers to check that a contracted follow-up provider has been informed of the ninety-day requirement, which is a plan detail the officer owns. Discarding the sample, testing without consent and imposing a short deadline all defeat that design. Primary reference: 29 CFR 1910.1030(f)(3)(iii)(B) (7-1-24 edition), printed p. 304.

23. Question 22

    A hospital selects a new safety-engineered intravenous catheter after its materials management committee reviews three vendors. No frontline clinical staff took part. What does the exposure control plan requirement add here?

    • The employer must solicit input only when the device is new to the market.
    • The employer must solicit input from non-managerial employees responsible for direct patient care in identifying, evaluating and selecting the controls, and document that solicitation in the plan.Correct
    • The employer must obtain written approval of the selected device from a majority of exposed employees. Where a majority cannot be assembled the employer may proceed on the recommendation of the safety committee, provided the vote is recorded in the exposure control plan.
    • The employer must purchase whichever device the frontline staff rank highest.

    Why: The duty is to seek input and to record that it was sought, identifying the employees or positions involved; it is not a vote and it does not bind the employer to the frontline preference. The directive notes that the employees chosen must represent the range of exposure situations in the workplace, and that laboratory workers without patient contact fall outside the provision. Nothing limits the duty to devices newly on the market. A committee of managers alone therefore leaves the plan defective even if the device chosen is a good one. Primary reference: 29 CFR 1910.1030(c)(1)(v) (7-1-24 edition), Exposure Control Plan, printed p. 297.

24. Question 23

    A part-time employee asks who pays for the post-exposure evaluation, the laboratory work and any prophylaxis. What does the standard provide?

    • All of it is made available at no cost to the employee, at a reasonable time and place, with laboratory tests conducted by an accredited laboratory at no cost.Correct
    • The employer pays for the evaluation, but laboratory work and drugs are billed to the employee's health plan and reimbursed on production of receipts once the exposure file has been closed and the incident accepted as work-related.
    • The employer pays only if the exposure is later confirmed to have involved an infected source individual.
    • The employer pays for a single visit; subsequent follow-up visits are a workers' compensation matter between the employee and the carrier.

    Why: The standard requires that all medical evaluations and procedures, including post-exposure evaluation and follow-up and prophylaxis, be made available at no cost to the employee and at a reasonable time and place, and separately requires that all laboratory tests be conducted by an accredited laboratory at no cost to the employee. Billing the employee's health plan and reimbursing receipts is not no cost, because it exposes the employee to deductibles and copayments. Making payment conditional on the source proving to be infected inverts the point of post-exposure follow-up. Splitting the first visit from later follow-up has no basis in the standard, which covers the follow-up as a whole. Primary reference: 29 CFR 1910.1030(f)(1)(ii)-(iii) (7-1-24 edition), Hepatitis B vaccination and post-exposure evaluation and follow-up, printed p. 303. Cross-reference: Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program (CDC, 2008), Direct costs, printed p. 143.

25. Question 24

    An employee reports a reaction to the examination gloves your service stocks. What does the standard require, and what limit does the enforcement directive place on the alternative?

    • The employer must substitute the alternative for all employees, since a mixed inventory is not permitted. Stocking two glove types is treated as a failure to select appropriate protective equipment, because the selection must be uniform across the classification.
    • The employee may be reassigned to duties without glove use, at the employer's discretion.
    • Glove liners, powderless gloves or similar alternatives must be readily accessible, and the alternative must give appropriate barrier protection and be approved as a medical glove.Correct
    • The employee must supply the alternative gloves and may claim reimbursement afterwards.

    Why: The standard requires that glove liners, powderless gloves or other similar alternatives be readily accessible to employees allergic to the gloves normally provided, and the directive adds the necessary limit: an alternative must supply appropriate barrier protection and be approved for use as a medical glove, at no cost to the employee. Reassignment is not the remedy the standard offers. Requiring the employee to buy the alternative conflicts with the no-cost rule. Nothing requires a single facility-wide glove. The directive also records that the word hypoallergenic may no longer be used to describe natural rubber products. Primary reference: 29 CFR 1910.1030(d)(3)(iii) (7-1-24 edition), Accessibility, printed p. 299.

26. Question 25

    An employer proposes that employees obtain the hepatitis B series through the group health plan, noting that the employer pays most of the premium and that the deductible is modest. Why does this fail the standard's no-cost requirement?

    • Because health plans may not lawfully cover occupational vaccinations.
    • Because the vaccine must be purchased through a Federal contract price schedule. Employers who buy outside that schedule are treated as having passed part of the cost to the employee, whatever the employee actually pays.
    • Because the vaccine must be administered on the employer's premises.
    • Because no cost means no out-of-pocket expense, and even a partial employee contribution to the premium or any deductible or copayment is unacceptable.Correct

    Why: The directive is unusually specific. No cost means no out-of-pocket expense, and the employer may not permit the employee to use health insurance to pay for the series unless the employer pays all of the insurance cost and the employee bears no deductible, copayment or other expense, because even a partial premium contribution exposes the employee to a premium rise. Using a spouse's or family member's plan is equally unacceptable, and so are reimbursement schemes conditioned on continued employment and amortisation contracts. Nothing requires the vaccine to be given on site or bought at any particular price. Primary reference: OSHA CPL 02-02-069, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, printed p. 48.