Ch. 4, 5, 6--Infection control & sterilization

The U.S. Environmental Protection Agency (EPA)

-Regulates medical & chemical waste -Registration of chemicals used in healthcare

Hepatitis B

-leads to liver disease or cancer -transmission: needle stick, sexual activity, childbirth, exposure to infected blood -leads to death, disability, liver disease -immunization -standard precautions in dental office

What are three types of gloves?

-medical examination gloves (what we use) -Sterile surgeon's gloves -Heavy-duty utility gloves (what we use)

What are three approved methods of sterilization?

-moist heat -dry heat -chemical vapor

What are factors affecting glove integrity?

-new pair for each patient -total time= 1 hour -storage: cool, dark place -chemicals can react with glove material (Petroleum jelly, aka Vaseline with Alcohol)

Surface category: environmental

-no contact with patient surfaces -countertops and equipment surfaces -intermediate disinfectant

Occupational Safety and Health Administration (OSHA)

-part of the U.S. Department of Labor -ENFORCES workplace safety regulations, including infection-control in healthcare settings

Protective eyewear

-prevent physical injuries and infections

HHV-1: Herpes simplex 1 disease manifestations

-primary gingivostomatitis -herpes labials -herpetic willow -ocular/ophtalmis

Face mask

-provides respiratory protection -barrier to spatter

Gloves and gloving

-purpose: prevent cross-contamination -must be: impermeable, strong/durable, non-latex, ergonomics

Degermination

-sanitization decrease number of organisms with soap

Antiseptic

-sanitization used on living tissues cannot be used as a disinfectant

Hepatitis C

-serological tests for antibody to detect -routine blood screening =1992 -transmission: primarily parenteral, same as HBV -no vaccine -standard precautions in dental office

Latex Hypersensitivity

-symptoms range: dermatitis- life threatening anaphylaxis

Surface category: semi-critical

-touch intact mucous membranes, oral fluids; does not penetrate soft tissue or bone -mirror and bite block -sterilize high level disinfection, or throw away

What are 3 different methods of cleaning instruments?

-washer/thermal disinfector -ultrasonic processing -manual cleaning

What are three features of protective eyewear?

-wide lens coverage around orbit area, with OSHA-mandated side shields to protect sides of eye -shatterproof -patient glasses tinted (prevent glare, cataract)

What is the OSHA shelf for unopened instruments?

1 year

Oral manifestations of HIV-1

extraoral exam: lymphadenopathy, skin lesions Intraoral exam: fungal infection (Candidiasis), viral infection, bacterial infection (linear gingival erythema, NUG/NUP) Dental hygiene management: refer symptomatic patients, help maintain quality of life, educate on home care

Hand care

effective hand washing to eliminate cross-contamination -fingernails: reservoir for microbes -CDC: no acrylic nails or polish

Resident bacteria

flora inhabiting the skin; reduced by hand washing

Face mask REMOVAL

grasp side elastic or tie strings to remove

Instrument washer/thermal disinfector

high-velocity hot water and detergent to clean instruments and dry them

Port of entry

infectious agent into new host

Viral hepatitis

inflammation of the liver

*Spore test

is used to determine sterilizer working properly

People allergic to latex many times have other allergies, such as...?

kiwi and bananas

Iodophors

may stain surfaces, inactivated by hard water broad spectrum

Port of exit

mode of escape form the reservoir Ex: secretions- saliva, blood; Skin and mucous membranes; Droplets

Hepatitis F & G routes

new, transfusion-transmission

What are four types of disinfectants?

-Glutaraldehyde -Iodophors -Phenols -Chlorines

HHV-4: Epstein-Barr Virus disease manifestations

-mononucleosis -oral hairy leukoplakia

Surface category: critical

-penetrates soft tissue or bone -needle and dental scalers -sterilize or throw away

*Instrument cassettes should not be unwrapped with the same gives to be used for the patient because the outside packaging is non-sterile after being exposed to the environment and may transfer microbes to the gloves. A. Both the statement and reason are correct and related B. Both the statement and reason are correct but not related C. The statement is correct, but the reason is not D. The statement is not correct, but the reason is correct

A. Both the statement and reason are correct and related

CASE: A dental hygienist is in a hurry and accidentally punctures a bloody scaler through her latex glove. This instrument was just used on an HIV-positive patient. Which of the following pathways of cross-contamination is depicted in this case? A. Client to dental team B. Dental team to client C. Client to client D. Office to community

A. Client to dental team

*Which of the following is an advantage of sterilization by steam under pressure? A. Will not corrode carbon steel instruments B. Most economical C. Suitable for oils and powders D. None of the above

B. Most economical

Face shields provide maximum coverage for the face and protection from spatter during oral healthcare procedures. Therefore, wearing a mask is not required when using a face shield. A. Both statements are TRUE B. Both statements are FALSE C. The first statement is TRUE, the second is FALSE D. The first statement is FALSE, the second is TRUE

C. The first statement is TRUE, the second is FALSE

HHV-5 is also known as...

Cytomegalovirus Virus (CMV)

*Which of the following packing materials should NOT be used with chemical vapor sterilization? A. Paper wrap B. Paper pouches C. Plastic pouches D. Cloth wrap

D. Cloth wrap- because it absorbs too much chemical vapor

When should the face mask be changed? A. Every hour B. When it becomes wet C. For each patient D. For each patient, when it becomes wet, and at least every hour

D. For each patient, when it becomes wet, and at least every hour

*Which of the following chemicals is not an intermediate-level disinfectant? A. Iodophor B. Phenol C. Chlorine D. Glutaraldehyde

D. Glutaraldehyde- high level

*You are the new office manager at your dental office. You are hiring a new assistant. What vaccine must you provide for her? A. Hep A B. Infectious mononucleosis C. TB D. Hep B

D. Hep B

What are three types of airborne infection? Pg. 48

Dust-borne organisms Aerosols Spatter

HHV-4 is also known as...

Epstein-Barr Virus (EBV)

Herpes labialis

HHV-1 genital and oral-fecal infections reactivation is frequent Recurrent triggers: stress, sunlight, illness, trauma Prodromal: prior lesion appearance, burning, stinging, tingling sensations with slight swelling may appear POSTPONE APPOINTMENT

Herpetic witlow

HHV-1 infection of the fingers that results from viral entry through minor skin abrasions

Ocular/ophtalmic herpes

HHV-1 transmission from splashing saliva or fluid from a vesicular lesion directly into an unprotected eye prevention: PPE

Primary Herpetic Gingivostromatitis

HHV-1 widespread oral ulcers that may involve pharyngeal areas fever, malaise, instability to eat, swollen lymph nodes

Shingles

HHV-3/Zoster virus chickenpox leaves lasting immunity VZV remains latent in the dorsal root gangliz

Cytomegalovirus

HHV-5 common in HIV/AIDS patients respiratory droplets, blood infusion, sexual contact, neonatal standard precautions, handwashing

Herpes hymphotropic virus

HHV-6/7 90% by age 5 have been exposed saliva, respiratory causes encephalitis, febrile seizures, neurological disorders Roseola infant (6 mo-2 yr)- high fever and rash

Kaposi's sarcoma-related herpesvirus

HHV-8/Kaposi's sarcoma saliva, genital secretions associated with all forms of Kaposi sarcoma "AIDS" defining lesion

*What vaccine also helps protect against Hepatitis D?

Hep B vaccine

HHV-6 is also known as...

Herpes Lymphotropic Virus (HLV)

HHV-8: KSRV disease manifestations

Kaposi's sarcoma, "AIDS" defining lesion

HHV-3 is also known as...

Varicella-Zoster Virus (VZV)

Where can latex proteins be found?

air

Phenols

degrades plastics over time broad spectrum

Fomite

inanimate object

Hepatitis A & E routes

oral-fecal route, unsanitary food & water

Infection potential

patients may be carriers of certain diseases, poor infection control and work habits of offices

Herpes Virus has been related to _________ disease.

periodontal

Transient bateria

some are pathogenic; most can be removed with soap and water OR 60-95% ethanol or isopropanol-based hand rubs

Cross-contamination

spread of microbes from one source to another

Susceptible host

does not have immunity to the invading infectious agent

When does simple oral flora develop?

within a few hours after birth

Hepatitis D

-Can only occur in the presence of HBV "B before D" -Transmission- superimposed on HBsAg carriers, multiple exposures, similar to HBV -Immunization with HBV vaccine also protects the recipient form delta hepatitis infection

HIV

-HIV-1 (America and Europe) -HIV-2 Can persist within cells such as macrophages (WBC) for long periods Semen, vaginal secretions, breast milk, blood Diagnosis: ELISA confirmed with Western Blot or IFA test T-helper cell % marker for progression

What are 5 pathogens transmissible by the oral cavity?

-Tuberculosis -Viral hepatitis -HPV -HIV -Herpetic infections

Face mask USE

-adjust mask BEFORE don eyewear and gloves -new mask for each patient -keep mask on after completing procedure, while still in presence of aerosols -do not handle contaminated side of mask with gloved or bare hands

Antiseptic hand rub

-alcohol-based -DECONTAMINATION -can use up to THREE times between washing

Spatter

-an airborne infection -heavier, larger particles may remain airborne a relatively short time because of their size and weight -particles greater than 50 um, may be visible -origin: created during breathing, speaking, coughing, or sneezing, produced during all dental procedures

Aerosols

-an airborne infection -less than 50 um in diameter -biologic contaminates occurring in solid or liquid form, are invisible, and remain suspended in air for long periods of time -particles may be breathed into lungs

Dust-borne organisms

-an airborne infection Clostridium tetani & enteric bacteria may travel into dental environment

When preparing the treatment room, how does a hygienist prepare the UNIT WATER LINE?

-biofilm of microbes can form on the inside of the water line tubing after overnight standing -flush lines for 2 minutes at start of day, 30 seconds between patients -contaminated water cannot be used for medical purposes = infection

HHV-3: Varicella-Zoster Virus disease manifestations

-chicken pox (primary) -shingles (secondary)

*Centers for Disease Control and Prevention (CDC)

-develop guidelines and recommendations -1 of 8 federal public health agencies within the U.S. Department of Health and Human Services -is NOT a regulatory agency (does not enforce the guidelines that it develops)

Surface category: noncritical

-does not touch mucous membranes -light handles; eyewear -intermediate disinfectant

Herpes virus diseases description

-endemic worldwide- over 95% -public health problem due to vaccinations -8 strains known to infect humans -latent and recurrent disease -can lead to cancer

What are four types of PPE?

-eye and face protection -masks -protective clothing -gloves (after proper hand washing)

Packing instruments

-follow manufacturer's recommendations -prevent punctures or tears -wrap permits steam or chemical vapors to penetrates through the contents -packages are kept completely sealed until unwrapped in front of the patient

HHV-2: Herpes simplex 2 disease manifestations

-genital herpes -oral and ocular; peri-oral

What are three types of protective eyewear?

-goggles (shielding on all sides of glasses) -eyewear with side shields -magnification loupes

Gloves: procedure

-gown, mask, eyewear PRIOR to gloving -glove placement: over cuff of sleeve -avoiding contamination: do not touch face, hair, mask, clothing -torn, cut, or punctured glove -removal of gloves: wash hands after

Chemical indicator tape

-incorporated chemical in the form of stripes-change color during the sterilization process -color change= autoclave has reached a certain temperature -does not indicate instruments are sterile -ID packages ready for use

What are three essential characteristics of a face mask?

1. FILTRATION- blocks 95% of BFE (bacterial filtration efficiency) particles as small as 3u) 2. FIT- vital to protect against inhaling nuclei from aerosols 3. MOISTURE ABSORPTION- mask lining should be impervious -mask should be changed for EACH PATIENT and be worn no longer than 1 hour

What are the five steps to remove gloves without cross-contaminating?

1. Use left fingers to pinch right glee near edge to fold back 2. fold edge back without contact with clean inside surface 3. use right fingers to contact outside of left glove at the wrist to invert and remove 4. bunch glove into the palm 5. with ungloved left hand, grasp inner non-contaminated portion of the right glee to peel it off, enclosing other glove as it is inverted

All surfaces and items that will be used or contacted during the appointment can be categorized as:

1. critical 2. semi-critical 3. noncritical 4. environmental *1 & 2- sterilized or disposed

Steam under pressure

121 C for 15-30 minutes mode of action: pressurized heat Cannot be used on: -oils, waxes, powder, imperious items to steam or high temps Adv: good penetration, short cycle, *economical Dis: *corrosive, dull instruments, doesn't dry well, destroys heat-sensitive items

HPV

124+ strains HPV 16 & 18: related to oropharyngeal cancer HPC 6 & 11: genital warts Immunization

Chemical vapor

132 C for 20 minutes mode of action: heated formaldehyde and alcohol Cannot be used on: -low melting plastics -liquids -heat-sensitive hard pieces Adv: no corrosion, no rust, short cycle times Dis: Requires ventilation, associated with odors

Dry heat

160 C for 2 hours OR 170 C for 1 hour mode of action: oxidation- heat conducted exterior to interior Used on items that can't use steam under pressure, small metal instruments that might corrode or rust with steam Cannot be used on: -anything that cannot be subjected to high temp Adv: no corrosion Dis: long exposure time, slow penetration of steam, destroys heat-sensitive items

Glutaraldehyde

A DISINFECTANT 7-10 hours **mode of action: emersion high level disinfectant Dis: long exposure time, harmful to skin

*High level disinfectant inactivate spores and all forms of bacteria, fungi, and viruses. Intermediate level disinfectants inactivate all forms of microbes but do not destroy spores. A. Both statements are true B. Both statements are false C. The first statement is false, the second statement is true D. the first statement is true, the second statement is false

A. Both statement are true

CASE: A dental hygienist is in a hurry and accidentally punctures a bloody scaler through her latex glove. This instrument was just used on an HIV-positive patient. What is the source of the microbes in this case? A. Client's mouth B. Hygienist's hands C. Client's skin lesion

A. Client's mouth

*Which of the following is true regarding the handling of regulated infectious water? A. Containers of infectious waste must be labeled with the biohazard symbol B. Infectious waste can be disinfected and then combined with the regular trash C. Infectious waste must be sterilized before leaving the oral healthcare setting D. Infectious waste does not require any special handling in some states

A. Containers of infectious waste must be labeled with the biohazard symbol

Which of the following is OSHA primarily concerned with protecting? A. Employee B. Employer C. Patient D. Community

A. Employee

Cross contamination refers to the spread of microbes from one source to another; this may include which of the following? A. Person to person, person to inanimate object, and inanimate object to person B. Person to inanimate object only C. Inanimate object to person only D. Person to person only E. Person to inanimate object and inanimate object to person only

A. Person to person, person to inanimate object, and inanimate object to person

*Wearing 2 pairs of gloves on an HIV+ patient is unnecessary based on: A. Standard precautions B. Exposure control C. FDA guidelines D. None of the above

A. Standard precautions

*Biological monitors containing spores of Geobacillus stearothermophilus are used to verify sterilization in which of the following methods? A. Steam autoclave B. Dry heat oven C. Ethylene oxide gas D. Rapid-heat transfer

A. Steam autoclave

*Of the following methods of sterilization, which one requires the longest time to complete? A. Chemical vapor B. Dry heat C. Moist heat D. Prevacuume autoclave

B. Dry heat

*Because _____ are the hardiest microbes, their destruction is required before the defined parameters/level of sterilization have not been met. A. Hep B viruses B. Bacterial endospores C. Mycobacteria D. Vegetative bacteria

B. Bacterial endospores

CASE: A dental hygienist is in a hurry and accidentally punctures a bloody scaler through her latex glove. This instrument was just used on an HIV-positive patient. Which of the following modes of disease spread is depicted in this case? A. Direct contact B. Indirect contact C. Droplet infection D. Airborne infection

B. Indirect contact

By which of the following mechanisms do aerosols gain entry into the bodies of oral health care workers? A. Ingestion B. Inhalation C. Non-intact skin D. Mucous membranes

B. Inhalation

*Which level of disinfectant does the CDC recommend for disinfecting clinical contact surfaces with visible blood in the oral healthcare setting? A. Low B. Intermediate C. High D. All the above

B. Intermediate

The majority of cases of transmission of HIV in adults is due to which of the following? A. Blood transfusion B. Needle sharing C. Sexual contact D. Contact with saliva

C. Sexual contact

*Mode of transmission

Direct contact- person to person Indirect contact- by way of an intermediate vehicle (needle, scaler, etc.)

Which of the following tests determines the progression of HIV? A. IFA B. T-cell % C. Western blot D. ELISA

B. T-cell %

*Dry heat pathogen

B. atrophies

*All of the flooding methods can be used to process semi-critical patient care items except which one? A. sterilize using heat sterilization method B. disinfect using intermediate-level disinfectant C. sterilize using a chemical sterilant D. Dispose of in a proper receptacle

B. disinfect using intermediate-level disinfectant

Tuberculosis infection occurs most commonly in which area? A. lymph nodes B. lungs C. kidneys D. liver

B. lungs

Which of the following is an autoclave? A. chemical vapor sterilizer B. sterilization achieved by steam under pressure C. dry heat sterilizer D. ethylene oxide sterilizer

B. sterilization achieved by steam under pressure

*Which of the following indicators is used to determine if a sterilizer is operating correctly? A. External indicator B. Integrated indicator C. Biologic indicator D. Chemical indicator

C. Biologic indicator

Which of the following modes of disease spread would be involved when spatter of the client's oral fluids contacts the mucous membranes of an oral health care worker? A. Direct contact B. Indirect contact C. Droplet infection D. Airborne infection

C. Droplet infection

*The greatest occupational health care worker risk for bloodbourne infections is: A. Hep C B. HIV C. Hep B D. TB

C. Hep B

The primary reason for routinely wearing latex free gloves is to: A. Help with glove donning B. Eliminate skin problems C. Reduce airborne latex proteins D. Reduce glove costs

C. Reduce airborne latex proteins

*What is the goal of infection control in the oral healthcare setting? A. Prevent all microbes from entering the patient treatment area B. Sterilize clinical contact surfaces between patients C. Reduce the dose of microbes that may be shared D. Eliminate all microbes from the source

C. Reduce the dose of microbes that may be shared

Oral healthcare workers wear masks to reduce the risk of inhaling or ingesting microbes exiting form the patient. Wearing a surgical face mask will provide protection against contacting a respiratory disease. A. Both statements are TRUE B. Both statements are FALSE C. The first statement is TRUE, the second is FALSE D. The first statement is FALSE, the second is TRUE

C. The first statement is TRUE, the second is FALSE

*A chemical indicator is used on the outside of packaging to identify which items have been processed through the sterilizer. The chemical indicator changes color when the packages are sterile. A. Both statements are true B. Both statements are false C. The first statement is true, and the second statement is false D. The first statement is false, and the second statement is true

C. The first statement is true, and the second statement is false

Alcohol hand based rubs may be used instead of hand washing between patients because the rubs have been found to be more effective than hand washing especially when visible soil is present. A. Both the statement and the reason are correct and related B. Both the statement and the reason are correct but not related C. The statement is correct, but the reason is not D. The statement is not correct, but the reason is correct

C. The statement is correct but the reason is not

*Which of the following characteristics BEST describes the use of protective barriers for patient contact surfaces? (i.e. tape on light handles) A. They need to be changed only when visibly solid B. They should not replace disinfection between patients C. They are ideally used for surfaces that are difficult to disinfect D. They decrease the cost of maintaining asepsis

C. They are ideally used for surfaces that are difficult to disinfect

CASE: A dental hygienist is in a hurry and accidentally punctures a bloody scaler through her latex glove. This instrument was just used on an HIV-positive patient. Immediately following the puncture of the finger, which of the following actions should the hygienist perform? A. Scrub the finger puncture area using a stiff brush B. Immerse the punctured finger in bleach for 1 minute C. Squeeze the punctured finger to let out contaminates D. Squeeze the punctured finger to let out contaminates and wash the finger with antimicrobial soap

D. Squeeze the punctured finger to let out contaminates and wash the finger with antimicrobial soap

The FDA develops the guidelines and recommendations, including infection-control guidelines for healthcare settings and OSHA enforces the guidelines. A. Both statements are TRUE B. Both statements are FALSE C. The first statement is TRUE, the second is FALSE D. The first statement is FALSE, the second is TRUE

D. The first statement is FALSE, the second is TRUE (CDC develops the guidelines)

Criteria for selecting a disinfectant in dental office

EPA approval -Tuberculocidal, bactericidal, viricidal, fungicidal -MSDS sheets needed

*Steam/Chemical vapor pathogen

G. stearothermophilus

Chicken pox

HHV-3/Varicella virus highly contagious direct contact, droplet, indirect contact with articles soiled by discharge from vesicles immunization

Oral hairy leukoplakia

HHV-4/Epstein-Barr virus high incidence in HIV/AIDS patients Tongue lesions appear as white linear lesions along the lateral borders

Infectious mononucleosis

HHV-4/Epstein-Barr virus standard precautions virus excreted through saliva "kissing virus"

Manual cleaning

Ideally, instrument are contained in cassette -wear PPE (heavy-duty gloves) -scrub with long-handled brush under running water, one instrument at a time and away from you -hold instruments low in sink -**least preferred method- risk injury

HHV-8 is also known as...

Kaposi's sarcoma-related herpes virus (KSRV)

Sterilization: selection of method?

MUSt provide complete destruction of all microbes, virus, spores -disinfectants will not kill spores

U.S. Food and Drug Administration (FDA)

Regulates all medical devices

HHV-6: Herpes Lymphotropic Virus disease manifestations

Roseola infantum

Clinical Course of HIV-1

Seroconversion- when antibody can be detected -6 wks-6 mo after exposure Incubation period- range from time of infection-->AIDS symptoms -coulbe 15+ years Early symptomatic HIV disease -CD4+ T lymphocytes 200-500 cells -many systemic symptoms Late-stage disease: AIDS -CD4+ count below 200 cells -pneumonia common cause of death -death in 1-3 years (untreated)

Patients with what disease have increased risk for latex allergies?

Spina bifida

Disinfection kills _______ in 10 minutes

TB -TB kill time is how disinfectants are ranked low, intermediate, or high (only low does not kill TB) -high Glutaraldehyde is used as a sterilant if equipment immersed for certain length of time

What is the goal in preparing the treatment room?

To control disease transmission and cross-contanimation

Standard precautions

an approach to infection control that protects healthcare providers and patients protects from pathogens that can be spread by blood, bodily fluid, secretion, excretion

Asepsis

any practice that controls the entry or survival of microbes in a defined work area can be done with sterilization, disinfection, or sanitization

Personal Protective Equipment (PPE)

attire worn to protect the provider exposure this is indicated when work practice controls cannot prevent exposure to blood and body fluids

Hepatitis B, C, & D routes

blood-bourns route, impacts DH

What serves as a port of entry for pathogens?

broken skin

Glutaraldehyde uses

can be used as a sterilant if immersed 7-10 hours

No _______ towels should be used when drying hands.

cloth

All blood borne exposure incidents must be ________.

documented

Chlorines: bleach

rapid-acting, corrosive, strong odor broad spectrum

What is the purpose of hand washing?

reduce bacteria flora to absolute minimum

Ultrasonic processing

safer than manual cleaning not a substitute for sterilization instruments must be completely immersed in solution

What is essential to ensure sterilization using moist heat?

space between objects to ensure access to steam

Tuberculosis

special consideration for disinfection methods Etiological agent: mycobacterium tuberculosis Transmission- inhalation (bact. small enough to pass through mask) Area of infection: lungs, oral cavity (tongue ulcer)

Open instruments lose ________ because of ____________ contamination.

sterility; airborne

Biologic monitor

test autoclave to ensure working properly

What is the goal of post-exposure management?

to contain the injury as soon as possible to reduce risk of transmission

Reservoir

where invading organisms live and multiply ex: people, equipment, instruments, water from tubing