CCMA Infection Control: Standard Precautions, OSHA Sharps Rules, and Sterilization

Infection control on the CCMA is a subject of exact rules, and NHA's CCMA test plan gives Infection Control and Safety 15 scored questions and names the authorities itself: "CDC guidelines for infectious disease" (k96), "guidelines for exposure to bloodborne pathogens (for example, OSHA...)" (k97), and disposal "as dictated by Occupational Safety and Health Administration (OSHA)" (task 3C8). This guide follows those sources, as checked on October 28, 2026.

What subdomain 3C covers

The nine tasks: follow standard and universal precautions (3C1) and infectious disease guidelines (3C2), use PPE including donning and doffing (3C3), hand hygiene (3C4), disinfection and sanitization (3C5), sterilization of equipment (3C6), aseptic technique (3C7), OSHA biohazard disposal such as sharps containers and biohazard bags (3C8), and post-exposure steps such as needle safety and eyewash stations (3C9).

The 19 knowledge statements (k92–k110) add pathogens and nonpathogens, the chain of infection, signs of infectious disease, epidemics and pandemics, alcohol-based rubs, sterilization techniques, medical and surgical asepsis, the order of cleaning and cleaning products, safety data sheets, chemical cautions, disposal methods, the exposure control plan, and logs for maintenance, temperature and quality control.

The chain of infection

CDC's epidemiology course describes the chain this way: transmission occurs when the agent leaves its reservoir or host through a portal of exit, is conveyed by a mode of transmission, and enters through a portal of entry to infect a susceptible host. Each link is a place to break the chain. Passy's mapping of this subdomain's topics onto the links:

CDC divides transmission into direct (direct contact and droplet spread) and indirect (airborne particles, vehicles such as objects, and vectors).

Universal, standard and transmission-based precautions

The test plan lists universal precautions (k99) and standard precautions (k100) separately, and they aren't the same thing:

• Universal precautions is OSHA's term. In the bloodborne pathogens standard, it means "all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens"
• Standard precautions is CDC's broader set for all patient care. CDC's standard precautions page lists hand hygiene, PPE "whenever there is an expectation of possible exposure to an infectious material," respiratory hygiene and cough etiquette, patient placement, cleaning and disinfecting equipment, devices and the environment, careful handling of textiles and laundry, and safe injection practices
• Transmission-based precautions are used "in addition to Standard Precautions," per CDC's transmission-based precautions page

CDC's airborne examples are tuberculosis, measles, chickenpox and disseminated herpes zoster. If a question is set in a medical office or clinic, the ambulatory placements in the table are the ones that apply.

Hand hygiene rules from CDC and OSHA

CDC's hand hygiene page for health care workers sets these rules:

• Alcohol-based hand sanitizer is the default. Unless hands are visibly soiled, CDC prefers it over soap and water in most clinical situations, and recommends at least 60% alcohol
• Soap and water when hands are visibly soiled, before eating, after using the restroom, and as an added precaution after caring for patients with C. difficile or norovirus during outbreaks
• Timing. About 20 seconds to rub sanitizer in; at least 15 seconds of vigorous washing, and CDC notes others recommend 20
• Gloves don't replace it. "Gloves are not a substitute for hand hygiene"

OSHA adds the legal duty: employers must ensure workers "wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment," and where no sink is available and antiseptic cleanser is used, hands must be washed with soap and running water as soon as feasible.

PPE: the order for putting it on and taking it off

CDC's PPE sequence poster (CS250672-E) gives the order. It notes that the type of PPE varies with the precautions required.

The poster adds three details worth knowing: remove all PPE before leaving the patient room except a respirator, which comes off after you leave and close the door; grasp a mask's bottom ties or elastics, then the top, without touching the front; and perform hand hygiene between steps if your hands become contaminated. OSHA's standard requires the employer to provide PPE at no cost, gloves whenever hand contact with blood or other potentially infectious materials can be anticipated, and masks with eye protection or face shields whenever splashes or sprays are possible.

Sequences are recall items, so a deck you review daily helps, and 580 planned CCMA flashcards are sorted by domain for that kind of review.

Cleaning, disinfection and sterilization

CDC's rational approach to disinfection and sterilization sorts patient-care items by risk:

CDC defines high-level disinfection as eliminating all microorganisms "except for small numbers of bacterial spores." Sterilization goes further, which is why critical items need it.

For sterilization in the office autoclave, CDC's steam sterilization page gives the two common temperatures and minimum times for wrapped supplies: 121 °C (250 °F) for 30 minutes in a gravity displacement sterilizer, or 132 °C (270 °F) for 4 minutes in a prevacuum sterilizer. CDC's recommendations add:

• Clean first. "Meticulously clean patient-care items with water and detergent" before high-level disinfection or sterilization
• Monitor every load with mechanical and chemical indicators, internal and external
• Biological indicators at least weekly, using spores of Geobacillus stearothermophilus for steam
• Storage. Under event-related storage, sterile packs stay usable "unless the packaging is compromised"; under time-related storage, label each pack with an expiration date

The order of cleaning

Knowledge statement k105 asks for the "order of cleaning." CDC's environmental cleaning procedures, written for health care facilities with limited resources, give two rules that work in any setting: proceed from cleaner to dirtier areas, and proceed from high to low, so dirt doesn't fall onto areas already cleaned. CDC's examples: bed rails before bed legs, surfaces before floors, floors last. For a blood spill, the same page says to wipe it up with absorbent material, clean with detergent and water, then disinfect with a facility-approved intermediate-level disinfectant. The U.S. legal duty is OSHA's: contaminated work surfaces must be decontaminated with an appropriate disinfectant "immediately or as soon as feasible" after any spill of blood or other potentially infectious materials. The WHO phlebotomy guideline gives one example concentration, a 1:10 dilution of 5.25% bleach left wet for 10 minutes on surfaces that tolerate it, prepared fresh daily.

OSHA's bloodborne pathogens rules for medical assistants

The bloodborne pathogens standard is the federal rule behind tasks 3C8 and 3C9. The points most likely to appear as questions:

After an exposure

The standard defines an exposure incident as eye, mouth, other mucous membrane, nonintact skin or parenteral contact with blood or other potentially infectious materials. Its steps:

1. Wash or flush immediately. Wash skin with soap and water, or flush mucous membranes with water, "immediately or as soon as feasible"
2. Report it, so the employer can make immediately available a confidential medical evaluation and follow-up
3. Follow-up includes documenting the route and circumstances, testing the source individual's blood when consent is obtained, testing the exposed worker's blood, post-exposure prophylaxis "when medically indicated, as recommended by the U.S. Public Health Service," and counseling

The WHO phlebotomy guideline adds the urgency: don't delay post-exposure prophylaxis, because beyond 72 hours it is not effective. For chemical splashes, OSHA's first-aid rule, 29 CFR 1910.151(c), requires facilities for quick drenching or flushing of the eyes and body within the work area wherever people may be exposed to injurious corrosive materials. Blood or other potentially infectious material in the eyes falls under step 1 above: flush with water immediately or as soon as feasible.

Safety data sheets

Under OSHA's hazard communication standard, employers must keep a safety data sheet for each hazardous chemical they use, "readily accessible during each work shift," on paper or electronically as long as access has no barriers. Every SDS is in English and has 16 numbered sections in a fixed order, starting with Section 1, Identification, and Section 2, Hazard(s) identification, with first-aid measures in Section 4, handling and storage in Section 7 and exposure controls and personal protection in Section 8.

Three infection control practice questions written by Passy

These are original questions in the exam's style. They aren't NHA items.

1. A medical assistant wore a gown, a mask, goggles and gloves. Following CDC's first example sequence, which item comes off first?

• A. Gloves
• B. Mask
• C. Goggles
• D. Gown

Keyed answer: A. CDC's first example removes gloves, then goggles or face shield, then the gown, then the mask or respirator, followed by hand hygiene. The mask is last in both of CDC's examples, and the gown comes off first only when it is removed together with the gloves.

2. Under CDC's classification of patient-care items, how should a reusable blood pressure cuff be processed between patients?

• A. Sterilization, as a critical item
• B. High-level disinfection, as a semicritical item
• C. Low-level disinfection, as a noncritical item
• D. Disposal after a single patient use

Keyed answer: C. A blood pressure cuff touches only intact skin, and CDC lists it among its noncritical examples. Critical items enter sterile tissue, semicritical items touch mucous membranes, and option D isn't a CDC requirement for a reusable cuff.

3. What does OSHA's bloodborne pathogens standard say about recapping a contaminated needle?

• A. Only if no alternative exists, one-handed or by device
• B. Allowed with two hands if gloves are worn
• C. Required before the needle goes in a sharps container
• D. Allowed if the cap rests on a clean surface first

Keyed answer: A. 29 CFR 1910.1030(d)(2)(vii) bars recapping unless the employer can show no alternative is feasible or a procedure requires it, and then only with a mechanical device or a one-handed technique. Options B, C and D all describe two-handed or routine recapping, which the rule doesn't allow.

Wrong answers on sequences tend to repeat, so it helps when they come back, and Redemption challenges in planned CCMA prep bring back the questions you missed.

How to study infection control for the CCMA

The CCMA study plan guide gives this subdomain about 6 of 60 hours. A way to use them, in Passy's words:

1. Hour 1: the chain of infection and the three kinds of precautions, with one example disease for each transmission-based type
2. Hour 2: hand hygiene and PPE order until you can write both from memory
3. Hours 3 and 4: the CDC item categories, steam sterilization numbers and the order of cleaning
4. Hours 5 and 6: the OSHA table, the exposure steps and the SDS sections, then mixed practice

These rules also run through the other clinical subdomains: sharps and exposure steps apply to every draw in the CCMA order of draw guide, and to every injection in the Clinical Patient Care guide. When you've finished the six hours, every missed infection control question waits in planned Fix It review for a second try.

Your next step with infection control

Write the PPE donning and removal orders and the CDC item categories from memory, then check them against the tables above. Then try the 20 free CCMA practice questions, which include a sharps safety scenario.