Infection Prevention and Occupational Safety
This domain tests protecting the patient and yourself at the same time. Exam stems cover standard precautions, sharps and exposure management, surgical site infection prevention bundles, and the physical hazards of the OR - smoke, lasers, radiation, chemicals, and fire. The correct answer is usually the one that follows a written protocol rather than improvising.
Standard precautions and PPE
Treat every patient's blood and body fluids as infectious. Perform hand hygiene before and after patient contact and after glove removal. Don PPE in order and doff it so contaminated surfaces never touch skin. Gloves are not a substitute for hand hygiene.
Sharps injury and exposure
Do not recap needles; pass sharps in a neutral zone or on a tray; never retrieve an item from a sharps container. After a percutaneous exposure: wash the site with soap and water (do not squeeze or scrub), report immediately to the designated officer, and begin the facility's exposure protocol. Source testing and post-exposure prophylaxis for HIV should start as soon as possible, ideally within hours. Hepatitis B is vaccine-preventable; hepatitis C is not, but is now curable - early follow-up matters.
Surgical site infection prevention
Prophylactic antibiotics within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolones), glucose control, maintenance of normothermia, clipping rather than shaving, strict sterile technique, minimal traffic, and timely redosing for long cases.
Physical hazards
Surgical smoke is evacuated at the source with a dedicated smoke evacuator, not the general room ventilation. For lasers, use wavelength-specific eyewear, a controlled access area, and a fire-resistant drape. Radiation safety follows ALARA: lead apron of at least 0.5 mm, thyroid shield, and a dosimeter worn outside the apron at collar level. Chemicals require the safety data sheet, closed containers, and appropriate ventilation - glutaraldehyde exposure causes airway sensitization. Waste is segregated: red bags for regulated medical waste, rigid puncture-resistant containers for sharps.
Worked example
During closure, a suture needle penetrates the scrub tech's glove. The correct sequence is glove removal, wash with soap and water, immediate report and incident documentation, and evaluation for source testing and HIV prophylaxis - not a bandage and a return to the field.
Traps that cost marks
Recapping needles; using room ventilation as smoke evacuation; wearing the dosimeter under the lead apron; delaying exposure reporting until the end of the case.