Infection Control 2nd Test CEs

All of the following statements are correct in relation to intermediate-level disinfectants EXCEPT which one? Intermediate-level disinfectants __________. A. are regulated exclusively by the FDA B. inactivate Mycobacterium tuberculosis, which is substantially more resistant to chemical germicides than ordinary vegetative bacteria, fungi, and viruses (with or without lipid envelops) C. with the exception of sodium hypochlorite, have no demonstrable sporicidal activity D. are labeled as "tuberculocidal hospital disinfectants"

a

All of the following statements are correct with respect to housekeeping surfaces EXCEPT which one? A. Extraordinary cleaning and decontamination of floors in healthcare settings is warranted. B. Cleaning the walls, blinds, and window curtains is recommended when they are visibly soiled. C. Housekeeping surfaces need to be cleaned only with soap and water, alternatively, a detergent/disinfectant may be used. D. The methods, thoroughness, and frequency of cleaning housekeeping surfaces and the products used are determined by healthcare facility policy.

a

All of the following strategies for spills of blood and OPIM are acceptable according to OSHA regulations EXCEPT which one? Removing visible organic matter with absorbent material such as disposable paper towels; discard it into a leak-proof properly labeled container; and then, disinfect the area with __________. A. household bleach, 1:10 v/v dilution B. an EPA-List D low-level disinfectant (i.e., hospital disinfectant with HIV and HBV claims) C. an EPA-List E intermediate-level disinfectant (i.e., hospital disinfectant with tuberculocidal, HIV, and HBV claims) D. EPA-List B intermediate-level disinfectant (i.e., hospital disinfectant with tuberculocidal claim)

a

An essential first step to ensure the success of the disinfection process on fomites is the physical action of scrubbing with a detergent and rising with water, which removes large amounts of microorganisms from surfaces. A. True B. False

a

All of the following statements are correct with respect to detergents and enzymatic cleaners except which one? A. Detergents with an acidic pH generally provide the best material compatibility profile and good soil removal. B. Enzymes, usually proteases, sometimes are added to neutral pH solutions to assist in removing organic material. C. Some cleaning solutions also contain lipases (enzymes that inactivate fat) and amylases (enzymes that inactivate starches). D. After cleaning, the instruments must be washed to remove detergent and enzyme residues.

a) Detergents with an acidic pH generally provide the best material compatibility profile and good soil removal.

Which of the following statements related to critical or semi-critical, or non-critical patient-care items is correct? A. Heat tolerant critical and semi-critical items must be sterilized by steam, unsaturated chemical vapor, or dry heat. B. Heat-sensitive critical items can be sterilized by ethylene oxide or by immersing them in liquid chemical germicides registered by the FDA as chemical sterilants. C. Non-critical items, when visibly soiled, must be disinfected with an EPA-registered hospital level intermediate-level disinfectant. D. All of the above are correct.

a) Heat tolerant critical and semi-critical items must be sterilized by steam, unsaturated chemical vapor, or dry heat.

Measures to prevent the spread of waterborne pathogens include all of the following EXCEPT which one? A. Pipe runs from the water main as long as practical. B. Hand hygiene and glove use. C. Barrier precautions. D. Eliminating or minimizing contamination at point-of-use fixtures.

a) Pipe runs from the water main as long as practical.

The presence of biofilms of waterborne bacteria (e.g., Legionella spp. and Pseudomonas aeruginosa) in dental unit waterlines has been confirmed. A. True B. False

a) True

Which of the following modes are likely to serve as a vehicle for the transmission for Legionella spp. from a contaminated water source? A. Ingestion of water. B. Aspiration of water or inhalation of aerosols. C. Direct contact with water. D. Indirect-contact transmission (e.g., from an improperly reprocessed device).

b) Aspiration of water or inhalation of aerosols.

All of the following statements are correct with respect to preparing and packaging instruments except which one? A. The individual instruments should be placed in individual self-sealed or heat-sealed plastic and paper pouches or arranged in rigid or perforated trays/cassettes and wrapped. B. Hinged instruments placed in various packs must be in a closed, locked position. C. Each instrument unit must have an internal indicator placed on the inside and, if the internal indicator cannot be seen, an external indicator must be applied to the outside. D. The packing material e.g., paper or plastic pouches and unwoven and woven wraps must maintain the sterility of instruments during transport and storage.

b) Hinged instruments placed in various packs must be in a closed, locked position.

All of the following statements relative to the sterilization monitoring record (SMR) are correct except which one? A. Documentation, in the form of a log, is an absolute requirement of quality assurance. B. Mail-in biological monitoring reports are maintained by the testing agency and there is no requirement for separate recordkeeping in the dental office. C. The SMR provides a mechanism for determining if a recall is indicated and, in combination with the date and sterilizer number on each pack, the extent of the recall. D. The sterilization monitoring record and the sterilizer maintenance record shall be maintained for a specified period of time (state dental board requirements may vary).

b) Mail-in biological monitoring reports are maintained by the testing agency and there is no requirement for separate recordkeeping in the dental office.

All of the following statements with respect to unsaturated chemical-vapor sterilizers are correct except which one? A. Unsaturated chemical-vapor sterilization involves heating a chemical solution, primarily alcohol with 0.23% formaldehyde, in a closed pressurized chamber. B. The advantage of using unsaturated chemical-vapor sterilization is that the instruments do not have to be dry before sterilization. C. When using an unsaturated chemical-vapor sterilizer federal, state and local authorities must be consulted for hazardous waste disposal requirements. D. Unsaturated chemical-vapor sterilization causes less corrosion of carbon steel instruments than steam sterilization because less water is present during the cycle.

b) The advantage of using unsaturated chemical-vapor sterilization is that the instruments do not have to be dry before sterilization.

All of the following statements related to laser plumes or surgical smoke, and aerosolized allergens EXCEPT which one? A. Lasers and electrosurgical units release laser plumes or surgical smoke containing gases, tissue debris, and aerosolized infectious agents. B. The presence of pathogens in laser plumes or surgical smoke will predictably cause disease. C. Exposure to aerosolized allergens can cause urticaria, asthma, allergic rhinitis, conjunctivitis, angioedema, and rarely anaphylaxis. D. The FDA banned all powdered surgeon's gloves because of unreasonable and substantial risk of allergic reactions.

b) The presence of pathogens in laser plumes or surgical smoke will predictably cause disease.

All of the following statements are correct with respect to sterilizing unwrapped instruments and their use except which one? A. Unwrapped the instruments must be thoroughly cleaned and dried prior to sterilization. B. When sterilizing unwrapped instruments mechanical indicators must be checked, but there is no requirement to place a chemical indicator with the items. C. Critical items sterilized unwrapped must be transferred from the sterilizer to the point of use by an aseptic method for immediate use. D. Unwrapped sterile instruments can become contaminated with dust, airborne organisms, and other contaminants and should never be stored.

b) When sterilizing unwrapped instruments mechanical indicators must be checked, but there is no requirement to place a chemical indicator with the items.

All of the following statements relative to boil-water advisory are correct EXCEPT which one? While the boil-water advisory is in effect __________. A. use bottled water for patient rinsing B. if hands are visibly soiled, use an alcohol-based handrub C. do not deliver water to the patient through point-of-use fixtures from the public water system D. do not use water from the public water system for handwashing

b) if hands are visibly soiled, use an alcohol-based handrub

All of the following items related to waste management and hazard communication compliance are correct EXCEPT which one? A. A small percentage of solid waste generated in oral healthcare settings is hazardous solid waste. B. A subset of hazardous solid waste is regulated medical waste. C. Universal waste includes chemical agents used or generated in the workplace, which pose a hazard to human health or to the environment when handled improperly. D. The federal OSHA and its counterpart state agencies are responsible for developing and enforcing rules for hazardous chemicals as they relate to workers' health and safety.

c

All of the following statements are correct with reference to carpeting and cloth furnishings in clinical setting EXCEPT which one? A. Carpeting and cloth furnishings harbor a diverse microbial population and allergens and should be vacuumed regularly; although, the bacterial and allergen burden is reduced only temporarily. B. Despite evidence of microbial growth and persistence, there is little evidence that carpets and cloth furnishings influence the rate of HAIs. C. There are specific recommendations against the use of carpeting and cloth furnishings in general patient-care areas. D. Avoiding carpeting and cloth furnishings in areas where spills are likely to occur is prudent because fully contaminating carpets and cloth furnishings is difficult.

c

All of the following statements are correct with reference to contaminated laundry EXCEPT which one? A. OSHA defines contaminated laundry as "laundry which has been soiled with blood or OPIM." B. Healthcare-associated infections linked to contaminated fabrics are so few that the overall risk of disease transmission during the laundry process is negligible. C. OSHA regulations prohibit home laundering of PPE, and experts agree that this regulation extends to uniforms and scrubs not contaminated with blood and OPIM. D. Employers must launder workers personal protective garments or uniforms and other laundry contaminated with blood and OPIM.

c

All of the following statements are correct with reference to disposable (i.e., single use) surgical gowns, drapes, and fabrics EXCEPT which one? A. Disposable (i.e., single use) surgical gowns, drapes, and fabrics must be resistant to liquids and microbial penetration. B. Disposable (i.e., single use) surgical gowns, drapes, and fabrics must be registered with the FDA to demonstrate their safety and effectiveness. C. The CDC offers specific recommendations regarding the use of disposable fabrics and textiles versus durable goods. D. Repellency and pore size of the fabric contribute to gown performance, but performance capability can also be influenced by the item's design and construction.

c

All of the following statements related to critical or semi-critical, or non-critical patient-care items are correct except which one? A. Heat-tolerant critical patient-care items confer a high degree of risk for infection if contaminated with pathogens and must be sterilized by a U.S. Food and Drug Administration (FDA)-cleared heat sterilizer. B. Heat-tolerant semi-critical patient-care items, including all dental handpieces, must be heat sterilized. C. Heat-sensitive critical items must minimally undergo high-level disinfection using an FDA-registered chemical sterilant/high-level disinfectant. D. Unless visibly soiled, for non-critical items dispo

c) Heat-sensitive critical items must minimally undergo high-level disinfection using an FDA-registered chemical sterilant/high-level disinfectant.

All of the following statements are correct with respect to sterilization and levels of disinfection except which one? A. Sterilization is a validated process that destroys all forms of microbial life. B. High-level disinfection kills all pathogens but not all bacterial spores. C.Intermediate-level disinfection kills mycobacteria, all nonlipid or small viruses (e.g., polio), all fungi, all vegetative bacteria, and all lipid or medium-size viruses (e.g., HBV, HIV), but not bacterial kill spores. D. Low-level disinfection kills some nonlipid or small viruses (e.g., polio), some fungi, all vegetative bacteria, and all lipid or medium-size viruses (e.g., HBV, HIV).

c) Intermediate-level disinfection kills mycobacteria, all nonlipid or small viruses (e.g., polio), all fungi, all vegetative bacteria, and all lipid or medium-size viruses (e.g., HBV, HIV), but not bacterial kill spores.

All of the following statements are correct with respect to storing sterilized items except which one? A. After the sterilization cycle is completed and the instrument units are dry and cool, inspect all packages for proper color change by visible chemical indicators. B. Instruments units should be stored in a clean, dry, closed cabinet. C. Storage practices for wrapped sterilized instruments are time-related, i.e., recognize that wrapped instruments maintain their sterility for a specified time. D. When the packaging is compromised (i.e., torn, wet, or open), the instruments should be re-cleaned, re-packaged in a new wrap, and re-sterilized.

c) Storage practices for wrapped sterilized instruments are time-related, i.e., recognize that wrapped instruments maintain their sterility for a specified time.

All of the following statements are correct with respect to sterilizing and high-level disinfecting with germicides except which one? A. Patient-care items must be rinsed with sterile water after immersion to remove toxic or irritating residues. B. Patient-care items must be handled using sterile gloves, dried with sterile towels, and delivered to the point of use in an aseptic manner for immediate use. C. The efficacy of the sterilization or high-level disinfection process using germicides is readily verifiable. D. Federal law requires that label instructions on FDA and EPA-registered products be followed (e.g., use-dilution, shelf life, storage, material compatibility, safe use, and disposal).

c) The efficacy of the sterilization or high-level disinfection process using germicides is readily verifiable.

All of the following statements are correct with respect to cleaning reusable instruments and other devices except which one? A. If visible debris (both organic and inorganic contaminants) is not removed, it will interfere with microbial inactivation and compromise the sterilization and disinfection processes. B. Factors to consider in selecting a cleaning method include (1) efficacy of the method, process, and equipment used; (2) compatibility with items to be cleaned; and (3) occupational health and exposure risks. C. The use of automated equipment (e.g., ultrasonic cleaner or washer/disinfector) is discouraged because manual cleaning of instruments is more efficient. D. If the manual method is used, the instruments must be placed in a leak proof, puncture-resistant container and soaked with a detergent, a disinfectant/detergent, or an enzymatic cleaner to prevent drying of contaminants.

c) The use of automated equipment (e.g., ultrasonic cleaner or washer/disinfector) is discouraged because manual cleaning of instruments is more efficient.

All of the following statements are correct with respect to droplets EXCEPT which one? Droplets __________. A. are particles of moisture greater than 5µ B. can contain infectious pathogens C. can be transported over a long distance, i.e., beyond 3 feet of the source D. are instrumental in spreading the influenza virus

c) can be transported over a long distance, i.e., beyond 3 feet of the source

All of the following are specifically designed point-of-use devices to ensure water quality when performing oral surgical procedures for the delivery of sterile irrigating fluid EXCEPT which one? A. Bulb syringe. B. Single-use disposable products. C. Air-water syringe. D. Sterilizable tubing.

c)Air-water syringe.

If barriers are not used and the surface is not visibly soiled, first clean then disinfect using __________. A. EPA-List D low-level disinfectant (i.e., hospital disinfectant with HIV and HBV claims B. EPA-List B intermediate-level disinfectant (i.e., hospital disinfectant with tuberculocidal claim) C. an EPA-list E intermediate-level disinfectant (i.e., hospital disinfectant with tuberculocidal, HIV, and HBV claims) D. All of the above.

d

Which of the following statements related to solid waste generated in oral healthcare settings is correct? A. Most solid waste generated in oral healthcare settings is non-hazardous solid waste, a subset of municipal solid waste. B. Standard methods of collecting, storing, transporting, and disposing of municipal solid wastes are regulated by state or local jurisdictions. C. Municipal solid waste regulations often include mandatory requirements for recycling certain materials (e.g., newspapers, cardboards, plastics, glass containers, etc.). D. All of the above.

d

For infection to occur, which of the following element of the "chain of infection" must be satisfied? There must be __________. A. a source of infectious agents, i.e., contaminated air, water or fomites B. a susceptible host exposed to an adequate number of sufficiently virulent microorganisms C. a mechanism to transfer or mode of transmission of pathogens from the source to the host D. All of the above.

d) All of the above are correct.

In healthcare settings pathogenic organisms can be detected __________. A. in air B. in water C. on fomites D. All of the above.

d) All of the above are correct.

Which of the following statements best describes Spaulding's classification of patient-care items? A. During the course of their intended use, critical items penetrate soft and hard sterile tissues or the vascular system. B. During the course of their intended use, semi-critical items contact, but do not penetrate nonintact skin or mucous membranes. C. During the course of their intended use, non-critical items come in contact with intact skin, but not mucous membranes. D. All of the above are correct.

d) All of the above are correct.

Which of the following statements is correct with respect to biological monitoring of the sterilization process? A. In oral healthcare facilities, BIs should be processed with a load in all sterilizers at least weekly. B. A BI must be processed in every load containing an implant and the implant should be quarantined until the result of the spore test is known. C. When biological testing is done in-office, the test BI must be incubated (along with a positive control from the same lot but not processed through the sterilizer) within two hours (or refrigerated). D. All of the above are correct.

d) All of the above are correct.

Which of the following statements is correct with respect to dry heat sterilization? A. Dry heat may be used to sterilize patient-care items that might be damaged by moist heat (e.g., burs and certain orthodontic instruments). B. Dry heat has the advantages of low operating cost and being noncorrosive. C. Dry heat is a prolonged process and the high temperatures required are not suitable for the sterilization of many instruments and devices. D. All of the above are correct.

d) All of the above are correct.

Which of the following statements is correct with respect to procedures to follow in the event of a positive spore test? A. In case of a positive spore test, the sterilizer should be removed from service and all records of physical and chemical monitoring since the last negative BI test should be reviewed. B. If the physical and chemical indicators demonstrate that the sterilizer is functioning correctly consider the possibility of operator error, using the same cycle that produced the failure, repeat the spore test immediately after correctly loading the sterilizer. C. If packaging, loading, and operating procedures have been confirmed as performing correctly and the repeat BI test is positive, the sterilizer should remain out of service until it has been inspected, repaired, and re-challenged with BI tests in three consecutive empty-chamber sterilization cycles. D. All of the above are correct.

d) All of the above are correct.

Which of the following statements is correct with respect to processing contaminated reusable patient-care items? A. There should be a central processing area (CPA) of adequate size with four successive stations for (1) receiving and cleaning; (2) preparation and packaging; (3) sterilization or disinfection; and (4) storage of sterilized units. B. Within CPA, each station should be physically separated to control traffic flow and to contain contaminants during the process. C. Reusable contaminated patient-care items must be transported from the point of use to the CPA in sealed, leak proof containers displaying a biohazard symbol. D. All of the above are correct.

d) All of the above are correct.

Which of the following statements is correct with respect to the use of chemical sterilants and disinfectants? A. Heat-sensitive critical items must be cleaned and sterilized by immersing them for 3-12 hours in liquid germicides registered by the FDA as chemical sterilants. B. Heat-sensitive semi-critical items must minimally undergo high-level disinfection, i.e., they must be immersed in an FDA-registered chemical sterilant, but for a shorter contact time (≥12 min.). C. Non-critical patient-care items, when visibly soiled, must be cleaned and disinfected (10-minute contact time for most products) using an EPA-registered intermediate-level disinfectant with tuberculocidal claim. D. All of the above are correct.

d) All of the above are correct.

Which of the following statements is correct with respect to the various quality assurance indicators of the sterilization process? A. Monitoring physical indicators involves observing the gauges or displays on the sterilizer and recording the time, temperature, and pressure associated with each sterilization cycle for each load. B. Chemical indicators use sensitive chemicals to assess critical variables (i.e., time, temperature, steam saturation) during a sterilization cycle and are applied either to the outside or placed on the inside of each instrument unit to be sterilized. C. Biological indicators (BIs), or spore tests, assess directly the killing of known highly resistant, nonpathogenic bacterial spores. D. All of the above are correct.

d) All of the above are correct.

All of the following statements with respect to steam sterilizers are correct except which one? A. Steam sterilization (autoclaving) is the most widely used method for wrapped and unwrapped critical and semi-critical items that are not heat and moisture sensitive. B. To kill microorganisms, steam sterilization requires exposure of each item to direct steam contact at a specified temperature and pressure for a defined period of time. C. The majority of tabletop sterilizers used in oral healthcare settings are gravity displacement sterilizers. D. Gravity displacement steam sterilizers should be tested daily for adequate air removal.

d) Gravity displacement steam sterilizers should be tested daily for adequate air removal.

Which of the following areas requiring special ventilation must be maintained by community-based oral healthcare facilities? A. Operating rooms. B. Protective environment rooms. C. Airborne infection isolation rooms. D. None of the above.

d) None of the above.

All of the following statements are correct with respect to sterilizing wrapped instruments loading instruments except which one? A. Perforated trays/cassettes should be placed so that they are parallel to the shelf. B. Non-perforated containers should be placed on their edge. C. Peel-packs should be placed on edge and small items should be loosely placed in wire baskets D. Once the sterilization cycle is complete, remove the packs to cool and dry onside the chamber.

d) Once the sterilization cycle is complete, remove the packs to cool and dry onside the chamber.