OSHA and CDC

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Microbial dose load

-the dose load of microorganisms present in a specific area

whats the difference between a universal and a standard precaution

.Treats all patients and materials as potentially infectious. a standard precaution would be more specific.

how many layers of instruments are permitted in the autoclave

1

*what are the three types of regulated medical waste

1. Blood and blood saturated materials 2. Pathological waste (e.g. tissues and extracted teeth) 3. Sharps

what are the steps in the processing cycle of instruments (6)

1. Instruments must be transported in a holding/transporting container from the operatory to the sterilization area 2. Optional holding solution if not cleaned immediately 3. Ultrasonic cleaning 4. Instrument packaging/Internal chemical monitoring/ Labeling 5. Sterilization process/Mechanical monitoring/ Biological monitoring 6. Instrument storage

what does the CDC do

1. collects scientific data and makes recommendation 2. tracks disease trends 3. protects workers AND patients 4. controls spread of infection

when were guidelines enforced

1991. mandatory blood born pathogens standards issued.

how often does our lab check for sterilization of spores

1x/week as per CDC, ADA and OSAP recommendation. varies state to state

how long do discharge water after each patient from any device connected to the water system that enters the mouth

20-30 seconds

What is the max amount of CFU in a dental water unit line recommended by ADA

200 CFUs

when should the solution be changed

2x/day or when cloudy

how are HBV shots given- sequence and timing of injections and titer reading

3 injections: day one, day 30 and 6 months. then 1-2 months later a titer is taken

how long are training records kept

3 years

what is an infectious agent

?The agents that cause disease fall into five groups: viruses, bacteria, fungi, protozoa, and helminths (worms).?

what is a pathogen

?a bacterium, virus, or other microorganism that can cause disease.?

what is infection control

A system of measures practiced by health care personnel

what does APIC stand for

Association for professionals in infection control and epidemioloy

types of sterilization methods

Autoclave ▸ Dry heat sterilizer ▸ Rapid heat transfer sterilizer ▸ Unsaturated chemical vapor- (chemiclave) ▸ Ethylene Oxide- ▸ Chemical sterilants-

which is preferred- barriers or disinfectants? why?

Barriers are preferred over disinfectants because they reduce exposure to chemicals and save time in operatory processing

what are airborne pathogens

Chickenpox, Influenza, Measles, Smallpox, Tuberculosis.

*Noncritical processing

Contacts intact skin (radiograph head/cone, blood pressure cuff)

a disinfectant must be registered with what organization

EPA

Hospital-level germicide

EPA registered germicide for disinfecting environmental surfaces in healthcare setting (noncritical surfaces)

chemical vapor sterilizer

Ethylene oxide

what is the goal of infection control

Goals to decrease transmission of infectious agents

which is more virulent- HBV or HIV

HBV. It lives 7 days outside the body. HIV lives for 30 minutes.

what are lipid or medium sized bacteria

HIV Herpes HepB and C

If a disinfectant is a tuberculocidal, it also kills what

HIV and HBV

what are blood born pathogens

HIV, HBV and HCV,

what are chemical indicators

Heat sensitive chemicals that display a color or a physical change once the inside of the sterilizer has reached a certain temperature

which is the most common occupational disease acquired in the dental setting

Hep B

what are the recommended CDC immunizations

Hep B Influenza MMR (measles, mumps, rubella) Tdap (tetanus, diptheria, pertussis) Varicella/chicken pox sometimes: meningitis and typhoid

what do you do if you got chemicals in your eyes

Irrigate with clean water, saline or sterile solution. Notify the Exposure Control Manager

Intermediate level disinfectant is used for what type of surface

NONCRITICAL

what is does the sharps and the needlestick prevention act mandate

New devices used for needlestick safety should be screened, evaluated by those who will use them, and forms should be kept in the written Exposure Control Plan as documentation of the OSHA mandate

Is latent TB infectious?

Night

what are other relevant organizations that have developed recommendations for safer workplaces

OSAP, ADA, ADHA, ADAA, APIC

what does OSHA stand for

Occupational Safety and health and administration

when cleaning the operatory, what should be worn

PPEs

where can you find detailed procedures regarding an exposure incident?

Postexposure Management Plan

besides hygiene, what are the otherduties/roles of the hygienist

Product selection ▸ Purchasing ▸ Inventory control ▸ Research

what are some ways to make patients aware of measures being taken to control exposure

Proper clothing in reception area and other general areas ▸ Open packaged sterilized instruments in front of the patient ▸ Offer patient eyewear ▸ Offer a pretreatment mouthrinse ▸ Wash your hands and don gloves in front of the patient

what is the correct order of donning PPEs

Protective clothing/Lab coat ▸ Eyewear ▸ Mask ▸ Gloves

what are high level disinfectants used on

SEMICRITICAL items that cannot withstand heat or ethylene oxide sterilization

*each chemical in the office must have a what

Safety data sheet (SDS)

how should instruments be stored

Should remain packaged for storage ▸ Storage area should be clean, dry and closeable

what are key factors in choosing disinfection chemical

Staff/patient compatibility, nontoxic ▸ Storage requirements ▸ Ease of use ▸ User satisfaction ▸ Shelf life ▸ Disposal ▸ Cost

Clinical contact surfaces

Surfaces that are touched by contaminated hands, instruments, devices, or other items, during dental or medical care

after treatment, where do contaminated instruments go

They should be transferred immediately to the instrument recirculation area

who established OSHA and when

US government in 1970s

what methods are used to insure patient safety regarding water borne illness

Use anti-retraction valves ▸ Use water treatment regimen according to manufacturer recommendations ▸ Use In-line filters

what is holding solution for

Used if instruments cannot be cleaned immediately after patient treatment

what does exposure control do

Uses the concepts and strategies of infection control to prevent exposure to infectious agents and limit the spread of infectious agents when exposure occurs

how is HBV spread?

VIRUS, bacteria, toxins, certain drugs or physical injury

How long does item need to be in autoclave to be sterile

Warm up plus 20 minutes and cool down

*what do you wear on your hands to transport bloodied instruments

Wear appropriate PPE's and utility gloves

when does waste need to be regulated

When there is a substantial risk of causing infection during handling E.g.: gauze saturated with blood

Is latent TB detectable

Yes it will show positive

what is toxic waste

a subset of hazardous waste and is capable of having a poisonous effect

what type of trainng takes place when there are changes in policies, procedures, or products, if new info is available, or if someone doesnt follow standards operatiiong procedures

additional training

*how often are handpieces sterilized

after every use

how is TB spread

airborne bacteria

what is bioburden

amount of biological or organic material on a surface. e.g. saliva

what are exposure controls

an all incompasing term. incorporates all the aspects of Infection Control with the related principles of occupational safety and health. goal is prevention.

what are OSHA universal precautions

an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens,

Noncritical surfaces

an item or surface in the treatment area that does not touch or penetrate human tissue, but may become contaminated by aerosolization, spatter, or contact with contaminated items.

which type of training is required for specific OSHA standards such as the Bloodborne Pathogens Standard and is good office policy

annual

what type of hazards does dental waste pose?

any combination of the infectious, chemical, and/or physical. most is general waste though.

what is hazardous waste

any waste that poses a risk or peril to humans or the environment, but does not have to be infectious

which handpieces should be sterilized

anything that can be removed (i.e. polisher)

labels on containers of hazardous chemicals must have what

appropriate hazard warnings id of the chemical manufacturers name and address

what is fungi

aspergilllus candida

which sterilization method uses steam heat under pressure

autoclave

Is TB a virus or bacteria

bacteria

when useing the ultrasonic, when do you rinse the instruments

before and after the cycle

what is the only full proof method to verify sterilization

biologic monitoring

what do automated methods of instrument cleaning do

break up and loosen debris

what does CDC stand for

center for disease and control

*what do employees need to know about the chemicals

chemical handling, safety and emergency response in the event of an exposure or spill in, specific to their job duties

high level immersion disinfectants, used for items that cannot withstand exposure to heat or ethylene oxide

chemical sterilants

if a disinfectant does not contain a surfactant, what is necessary before disinfecting

cleaning

if using a computer to document client info, what type of environmental control is being observed when you wipe it down

clinical contact

two subcategories of environmental controls

clinical contact surfaces housekeeping surfaces

Biofilm

colonization of slime protected microbial communities that may harbor bacteria, fungi, protozoa and microscopic nematode worms

*Semicritical processing

contacts mucous membranes or non-intact skin (mouth mirror, impression trays, dental handpieces)

how is staph spread

contaminated hands of health care professionals, by contact. May live several weeks outside host

what type of processing for periodontal instruments

critical

what are the 3 categories of procedures for processing instruments

critical semicritical noncritical

what the different ways we can monitor sterilization

cycle indicators, chemical indicators biologic monitors

how should packages be labeled

date of sterilization, cycle number and type of instruments (unless packaging is clear), name or initials of packager, and sterilizer used

*what is the cradle to grave concept

dental practice is responsible for the hazardous waste it generates until it is destroyed or rendered nonhazardous ▸

what does the sterilization process accomplish

destroys all microbial forms including bacterial endospores

what water is used for the autoclave

distilled

an agents ability to infect depends on what two factors

dosage (how much) virulence (how strong)

how is TB spread?

droplet nucei in the air

if there is exposure to a patients body fluid what happens next

employee with see their health care provider, take baseline tests, review patient's information and possibly given post exposure prophylaxis. counseling is provided if there is a positive test result. Possible workers comp

what does OSHA mandate

employers must "furnish to each of his employees, employment and a place of employment, which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."

type of control? operating the heat sterilizer

engineering control

Housekeeping surfaces

environmental surfaces that are not involved in the direct delivery of dental care (floors, walls)

with which gloves are clean barrier placed

examination gloves

which type of OSHA control has programs that are part of the offices standard operating procedures and practices and should be routinely evaluated

exposure control

Government stipulations are that all employees be aware of its contents and prescribed procedures which can be found in the _________?

exposure control manual.

true or false: the garbage man is responsible for proper disposal of hazardous dental waste

false. the dentist is and must keep a record

All confidential employee medical records must be kept for how long

for duration of employement and 30 years after

what can be done to keep sharp instruments from piercing the package before sterilization

gauze can be placed around sharp instruments

resistance of a host depends on what two factors

general health immunization status

what are the most common mechanism of transporting contamination

hands

what type of waste are lead foil, amalgam, spent fixer

hazardous waste

what type of waste is an extracted tooth filled with amalgam

hazardous waste

is immersion disinfection intermediate or high level sterilization

high level

the following are what type of disinfectant: Glutaraldehydes, hydrogen peroxide, paracetic acid

high level

what type of disinfectant would a mouth impression tray be submerged in

high level

*which level of disinfectant can kill: endospores, TB, hydrophilic and lipophilic viruses, fungi and vegetative bacteria

high level disinfectant

type of control? cleaning the counters daily

housekeeping controls

what type of container should be used when transporting instruments after treatment (dirty instruments)

in a container that is puncture resistant, leakproof with solid sides and bottom and has a biohazard label, a lid would be valuable

*when do we open clean, packaged instruments

in front of the patient

where are workplace emergency procedures kept

in the comprehensive emergency procedures plan

what are the three areas where employees are at risk of potential exposure

infectious chemical physical

what 3 items do the SDS sheets describe

ingredients, hazards and emergency procedures for each chemical

what are the three types of OSHA trainign in the work place

initial additional annual

what type of training is given when there is a change in responsibilities of staff, office procedures wheere there is a potential for an occupational hazard and in response to changes in governemtn regulations or recommendations

initial training

the following are what type of disinfectant: Iodophors, alcohol, synthetic phenolics, dual or synergized quaternaries, sodium bromide and chlorine

intermediate level

which level of disinfectant kills: TB, hydrophilic and lipophilic viruses, fungi and vegetative bacteria

intermediate level disinfectants

if you have a positive TB test but you are not infectious, what do you have

latent TB

how much time should a surface disinfectant require to kill TB

less than 10 min

Which level of disinfectant kills: Destroys certain viruses and fungi but not TB

low level

what type of disinfectant is needed to kill vegetative bacteria and lipid viruses: e.g. staph, salmonella, HIV, herpes,

low level hospital disinfectant

*what are the three levels of disinfectants

low level intermediate high level

what disinfectant is used for general housekeeping

low level disinfectant

which level of disinfectant is used on a clinical contact surface not contaminated with blood

low level disinfectant

simple quaternary ammonium compounds, detergents

low level disinfectants

how to wash hands

lukewarm water interlace fingers 15 seconds rinse and dry thouroughly turn off faucet with towel

Hospital level disinfectants

most critical to infection control and use on dental instruments, floors, walls, bed linens, toilet seats and other surface

TB is what bacteria

mycobacteria mycobacterium tuberculosis

are medical hx questionnaires reliable

no

does the ultrasonic sterilize

no

if a package of instruments is opened, is it still sterile

no

is there a pre or post exposure prophylaxis for HCV

no

is there a vaccine for Hep C

no

are sterilization chemical indicators full proof

no because the autoclave could have reached the target temp but not for the full 20 min. also still need to check for endospores

is there an increased risk for HCW to contract HCV? why?

no. Spread primarily through BLOOD contact, sexual transmission or during pregnancy

can PPE's last forever

no. they have an expiration date

what type of processing for a BP cuff

non-critical

the arm of the operatory would be considered what type of surface

noncritical. still requires wiping due to aerosolization

where is a face mask placed when walking out of the operatory

on a paper towel

can we sterilize unpackaged instruments

only in specific situations

what does OSAP stand for

organization for safety, asepsis, and prevention

what type of waste is an extracted tooth

pathological waste

*Critical processing

penetrates soft tissue, contacts bone, enters into or contacts the bloodstream or other normally sterile tissue (surgical instruments, periodontal scalers)

what are nonlipid or small viruses

polio coxsackle rhinoviris

what are over gloves used for

prevention of cross contamination e.g. using the keyboard

when are packages labeled

prior to sterilization

what does OSHA do

protects the health and safety of all workers

what is the purpose of packaging instruments

provides a barrier for instruments after sterilization

what is the CDC

public health agency in the US

can you tell if someome has HBV

rarely. 80% of the time no symptoms show. and 50% of people dont know they have it

infectious sharps and infectious nonsharps

regulated medical waste

*what if there is a tear in the packaging after sterilization

repack and re-sterilize

*if there is any death of hospitalization of 3 or more workers, that must an office do

report it to OSHA

which items should undergo immersion disinfection

reusable semicritical items that cannot withstand heat or ethylene oxide

what are post exposure management policies for bloodborne exposures

see designated HCP patient tested (if they agree) post exposure prophylaxis counseling this is at no cost to the employee

what type of processing for a dental film holder

semi-critical

if handling a physical patient's record/file during treatment, what are the risks to exposure to HIV

spatter, aerosols, contact with treatment gloves and equipment. pt records should never be in close proximity to clinical area

how do you clean the operatory

spray wipe spray

how are Chickenpox/Varicella Zoster, Flu/Influenza spread?

spread through droplets. N95 mask recommended

What is vegetative bacteria

staph salmonella

what type of water is used if bone is exposed

sterile

the higher the _____, the better at breaking up dirt and debris

surfactant

compare surgical hand antisepsis and regular hand washing

surgical hand washing involves washing hands AND arms. antiseptic hand rub involves alcohol based hand rub. regular hand washing involves the use of soap

who is responsible for laundering lab coats

the dentist

who pays for HBV immunizations

the dentist

Low level disinfectants

the major source of products used in households, swimming pools and water purifiers ▸

what is antisepsis

the practice of using antiseptics to eliminate the microorganisms that cause disease.

Disinfection

the process of decontamination, which kills most microorganisms, with the exception of spore-forming organisms left on a surface after cleaning

what is biologic monitoring

the use of paper strips or glass vials containing non-pathogenic highly resistant bacterial endospores

what happens if the sterilizer is overloaded

there will be cold spots

how are immersion disinfectants verfied for sterilization

they arent

what is the purpose of having an exposure control manager

they manage the practice's training program and ensure documentation is properly maintained

what is the purpose of cleaning an operatory before disinfecting it

to reduce bioburden

Cleaning

to remove visible debris and dirt by use of a detergent and mechanical means prior to disinfection and/or barrier protection

*true or false: CDC requires maintenance of records of work related medical management

true

True or false: New label only applies when product is removed from the original container, then must contain same information as original label

true

true or false, the FDA considers barriers as medical devices

true

you wear a face mask with a face shield. true or false

true

true or false: patient exam gloves are considered a medical device

true. regulated by the FDA.

what are the differences between OSHA and CDC

two distinct organizations OSHA oversees safety of work practices to protect workers CDC oversees public health

how to test for effectiveness of automated cleaners (e.g. the ultrasonic)

use a strip of aluminum foil 2X3 inches for 20 seconds and check in light for small holes, which should be present

what type of control? wearing heavy duty utility gloves, eye protection, etc

use of PPEs

what are the precautions of handling sharps

use single handed method of recaping use disengaging device to uncap dispose of sharps immediatelly wipe debris on taped down cotton rolls fulcrum a tooth that you arent working on only hold one instrument in a hand at a time

what are CDC standard precautions

used for all patient care. They're based on a risk assessment and make use of common sense practices and personal protective equipment use that protect healthcare providers from infection and prevent the spread of infection from patient to patient. e.g. donning PPEs and hand hygiene

what are utility gloves used for

used for handling contaminated sharps sanitized after use not a medical device

how long does sterilization take

warm up time 20 min then cool down

what do you do if you got someones body fluids on your broken skin/rash

wash with soap and water Notify the Exposure Control Manager

what do you do for a puncture wound

wash with soap and water and control bleeding. Notify the Exposure Control Manager

when should you use a face shield

when using an Ultrasonic scaling, air polishing and high-speed handpieces

how are protective glasses cleaned

with soap and water

type of control? proper training on how to use the sterilizer

work practice controls

who does OSHA protect

workers/employees

what are the 5 main parts to the chemical hazard communications program

written program chemical inventory SDS container labeling employee training

what are these: Standard Operating Procedures ▸ Employee Health Records ▸ Employee Training Records ▸ Emergency Procedures Plans ▸ Chemical Safety Records ▸ Dental Waste ▸ Miscellaneous

written reports

is saliva a potentially infectious material?

yes

is there a higher number of bacteria in untreated dental unit water lines

yes

is an immersion disinfectant considered a medical device by the FDA

yes (most are hazardous chemicals)

Are PPE's considered medical devices?

yes they are regulated by the FDA

can OSHA request copies of training records

yes to verify compliance

*is amalgam hazardous waste

yes contains mercury

is there a difference virulent factors when stuck with a needle used on a patient in early stages of HIV verses late stage

yes. but otherwise, usually the risk is .3%

what information is included in the training documentation

▸ Date and length of training ▸ Conductor of training and qualifications ▸ Names and job titles of attendees ▸ Content of training

what are the four steps of managing regulated waste

▸ Handling, segregating and storing ▸ Labeling ▸ Disposing ▸ Record keeping

when handling sharps, what are some ways to prevent an injury

▸ Never recap needles using two hands ▸ Never disengage a capped needle from a syringe by hand ▸ Dispose all non reusable sharps in a sharps container ▸ Never wipe debris from an instrument with gauze ▸ Never fulcrum on the same tooth you are working on ▸ Always hold instruments by the handle and one at a time

What are at least 3 responsibilities of the ECM

▸ Scheduling and monitoring training for all personnel ▸ Maintaining training materials and records ▸ Customizing the course materials for the office setting ▸ Answering questions and providing ongoing training ▸ Determining where, how and which employees are at risk ▸ Exposure risk is made without consideration to PPE's used

what are the housekeeping records (5)

▸ Sterilization monitoring log ▸ Biologic monitoring log ▸ Equipment maintenance and repair ▸ Dental unit waterline maintenance log ▸ Housekeeping schedule

what are the OSHA required protection methods

▸ Universal/Standard Precautions ▸ Work practice Controls ▸ Engineering Controls ▸ Personal Protective Equipment ▸ Environmental Infection Control

what are some ways to reduce aerosolization and splatter

▸ Use high-volume evacuation (HVE) ▸ Use a dental dam ▸ Use correct PPE's ▸ Use a preprocedural mouthrinse for each patient to reduce microbial dose load

what are the 5 primary controls/protection methods

▸Universal/Standard Precautions ▸ Work practice Controls ▸ Engineering Controls ▸ Personal Protective Equipment ▸ Environmental Infection Control


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