OSHA and CDC

What does the medical waste tracking act state?

"Cradle to grave" concept

What does CDC call work practice controls?

"safe work practices"

How long should inventory of chemicals be kept?

*30 years*

Biological monitors

*Only method to verify sterilization* -Paper strips or glass vials containing nonpathogenic highly resistant bacterial endospores -Endospores should be killed

What is an immersion disinfectant and when is it used?

*Type of high level disinfection/sterilization* for reusable semi-critical items that cannot withstand heat or ethylene oxide

what circumstances allow a patient with TB to see the dentist?

*only if it is an emergency*

What happens if an exposure requires medical intervention for an employee?

- the employee should immediately be sent to the designated healthcare provider - review patient's medical history and test for diseases -This will determine course of treatment

Intermediate level disinfectant cleaning ability and what does it kill?

-*only disinfects* -Destroys TB, hydrophilic and lipophilic viruses, fungi and vegetative bacteria

Hep B immunization includes how many injections, what type and when? Is there a follow up?

-3 injections given intramuscularly, day 1, day 30 and day 180(6 months) -1-2 months later a titer antibody test SHOULD be taken

Engineering controls

-A device, piece of equipment, or technology that removes or isolates a hazard in the workplace

What do chemical safety records consist of?

-A list of chemicals kept in the dental office -Each chemical must have a safety data sheet (SDS) on file *regular inventory of chemical must be taken*

What is infection control and what is its goal?

-A system of measures practiced by health care personnel Goal: decrease transmission of infectious agents

OSHA Bloodborne Pathogens Standard of 1991 states what regarding Hep B?

-All healthcare employers must make available and pay for hep B immunizations for all employees who have potential to be exposed

How should instruments be handled when in use?

-Always hold instruments by the handle and one at a time

What needs to be sterilized from the dental unit?

-Anything that can be removed from the air and water lines of the dental until between patients should be sterilized

What are the types of sterilization methods?

-Autoclave: sterilizer that uses steam heat under pressure -Dry heat sterilization -Rapid heat transfer sterilizer -Unsaturated chemical vapor- chemiclave -Ethylene oxide- chemical vapor sterilization -Chemical sterilants

When should hand washing be performed?

-Beginning of patient care -between patients -when donning or removing gloves -at the end of patient care

Who recommends biologic monitoring be done on a weekly basis?

-CDC, ADA, OSAP

Infectious nonsharps need to be places in what kind of container?

-Closeable, contain all contents, prevent leakage of fluids, labeled and/or color coded red, closed prior to removal, usually 3 mil or thicker plastic bad -Refrigerate if needed to prevent decomposition

Infectious sharps need to be placed in what kind of container and when should it be disposed of?

-Closeable, puncture-resistant, leakproof, with biohazard label or color coded red -Disposed when 3/4 full *must be in area where sharps are used*

OSHA requires employers to keep information in employees medical records: ___________, ___________, ____________.

-Confidential -Maintained for all of employment plus 30 years -Not disclosed or reported without employees written consent to any person *EXCEPT* required by OSHA

What are the 3 categories of instruments?

-Critical -Semicritical -Noncritical

What are some ways to monitor sterilization?

-Cycle indicators, chemical indicators and biological *document monitoring*

What info is needed in training documentation?

-Date and length of training -Conductor of training and qualifications -Name and job title of attendees -Content of training

Exploding bomb

-Explosives -Self-reactives -Organic peroxides

What are the examples of facial barriers?

-Face masks -protective eyewear -face shield

Infectious waster is defined by what regulations?

-Federal -State -Local

Bacteria, viruses, and fungi are found throughout where? How are they carried?

-Found throughout the body -Carried by blood, saliva, or other body fluids

What are the four steps for management of regulated waste?

-Handling, segregating, storing -Labeling -Disposing -Record keeping

In the hazard communication standard, what key terms changed?

-Hazard determination to hazard classification -Material safety data sheet to safety data sheet?

Chemical indicators

-Heat sensitive chemicals that display a color or a physical change once the inside of the sterilizer has reached a certain temp -Indicator must be specific to the sterilization method used *does not guarantee sterilization occurred*

What is HIV and what is it associated with?

-Human immunodeficiency virus -associated with acquired immune deficiency syndrome (AIDS)

When can a face shield be worn without protective eyewear?

-If made of high impact plastic and large enough, can be worn without protective eyewear -Usually worn with face mask

What are the three types of training needed in a dental office?

-Initial training -Additional training -Annual training

What is an instrument washer used for?

-Instrument cleaning *must be cleared by FDA* -use higher temps than regular dishwashers

Transmission-Based precautions are used for what diseases?

-MRSA -Chickenpox/varicella zoster -Flu/Influenza -TB

What are patient examination gloves made of? what is the difference when it comes to chemicals?

-Nitrile: prevent chemicals from going through -Latex: does not prevent chemicals from going through

Why must we assume that all patients, all providers, and all body fluids are potential transmitters of infectious agents and are potential sources for contamination?

-Patients may be unaware they are infected -Patients may not wish to reveal a known infectious disease -Medical history questionnaires cannot be completely relied upon

What are some tips for gloves?

-Power-free gloves advisable, some may have sensitivity to powders -Respiratory issues with powders -some have allergy to latex -contact dermatitis can develop -Should fit snugly but comfortably without being tight

What is the correct order of putting on PPE?

-Protective clothing/Lab coat -Eyewear -Mask -Gloves

What are some additional requirements for regulated waste?

-Registration with a state agency for each type of regulated waste -Some states require a license or permit -Transport license may also be required

What does annual training consist of?

-Required for specific OSHA standards such as the Blood-borne Pathogens Standard -Recommended as good office policy

Work practice controls

-Safe work habits -Methods of performing a task that reduce the chance of an exposure incident

What is the exposure control manager responsible for?

-Scheduling and monitoring training for all personnel -Maintaining training materials and records -Customizing course material for the office setting -Answering questions and providing ongoing training -Determining where, how and which employees are at risk

Handpiece sterilization

-Should be sterilized between patients -Follow manufactures instruments on lubrication and sterilization

What are the different types of face shields?

-Single-use, disposable -Reusable

Corrosion

-Skin corrosion/Burns -Eye damage -Corrosive to metal

What is the sequence for cleaning and disinfecting the operatory with spray? with wipes?

-Spray, wipe, spray -For wipes, follow manufacturer instructions

How is Methicilin-resistant staphylococcus aureus (MRSA) spread? Ho long can it live without a host?

-Spread on transiently contaminated hands of healthcare professionals, by contact -May live several weeks outside host

Dental practices use written reports for what?

-Standard operating procedures -Employee health records -Employee training records -Employee procedures plan -Chemical safety records -Dental waste -Miscellaneous

What are two disadvantages of immersion disinfectant?

-Sterilization cannot be verified by biological monitoring -Most are hazardous chemical

For housekeeping records, what logs are suggested to keep?

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

What occurs if biological monitors come back with positive results?

-Sterilizers must be used until fixed

What procedures are face shields required?

-Ultrasonic scaling, air polishing and high-speed handpicks which may generate large volumes of water

What are the primary controls or protection methods?

-Universal/standard precautions -Work practice controls -Engineering controls -Personal protective equipment -Environmental infection control

What is recommended when using dental waterlines?

-Use anti-retraction valves: water does not get sucked back into the line -Use water treatment regimen according to manufacture recommendations -Use In-line filters

How can we minimize aerosolization and spatter to protect ourselves?

-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 some tips for using ultrasonic cleaners?

-Use solutions designed for the machine and don't overload machine -Rinse instruments both before and after the cycle -Allow to dry completely

When is intermediate level disinfect used?

-Used for clinical contact surfaces -Used for noncritical surfaces

EPA definition for disinfectant

-Used on hard inanimate surfaces and objects to destroy or irreversible inactivate infectious fungi, viruses and bacteria, but not necessarily endospores

When should gloves be removed?

-When leaving treatment area -torn or damaged gloves must be immediately changed

When does additional training take place?

-When there are changes in policies, procedures or products -If new info is available or if there are changes in recommendations or regulations -If someone does not follow standard operating procedures

When does initial training take place?

-When there is a change in responsibilities of staff or infection control manager -When there is a change in office procedures where there is a potential for occupational exposure/hazard -In response to changes in government regulations or recommendations -When new to a dental office

When are aerosols and spatter created?

-When using ultrasonic scalers, high-speed handpicks or air/water syringes

What is a safety data sheet (SDS) and who prepares it?

-Will describe the ingredients, hazards and emergency procedures of each chemical -Manufacturer required to prepare SDS

For workplace emergency procedures, when is a written plan needed and when is an oral plan needed?

-Written plan with 11 or more employees -Oral plan with 10 or less employees

Classification of hazardous waste generators: Hazardous waste 3 types

-conditionally exempt small quantity generator: less than 100 kilograms -small quantity generator: 100-1,000 kilograms -large quantity generator: 1,000+ kilograms

What should be labeled on the packaged instruments?

-date of sterilization -cycle number and type of instruments (unless package is clear) -initials of packager -sterilizer used *label prior to sterilization*

What is PPE designed for? Where should it be worn?

-designed to protect your body -For clinical treatment areas only -Should not be worn outside the office

How can an organism enter the body through various routes?

-direct contact, indirect contact and spatter and aerosols

What are some requirements for barriers?

-fluid-proof -If plastic wrap is used, it must meet the FDA weight standards for food wrap

What about the host can help fight infection?

-general health -immune system -Immunization status

What should protective eyewear be made of? What is it designed to cover?

-high impact plastic -designed to completely cover over and around the eyes included solid, not vented, side shields

When is sterilization of unwrapped instruments allowed?

-may be done in specific situations such as during a surgery and an instrument is needed

Nails and jewelry requirements while working

-nails should be short and no artificial nails -No hand jewelry should be worn especially with gloves

When should barrier protected items be cleaned?

-not necessary to do in between patients but should be cleaned at the beginning of the day, end of the day and during the day if the barrier is compromised

What are the three types of gloves?

-patient examination gloves -Overgloves -Utility gloves

Exposure control manual

-practice's training and safety program manual -Government stipulations are that all employees be aware of its contents and prescribed procedures -Location of manual must be known

What is your role in the office besides hygiene?

-product selection -purchasing -inventory control -research -keep up to date on new products and info to make informed choices -follow manufactures directions for products

Plan treatment

-promote an efficient and safe working environment by checking the patient chart and treatment plan -set up operatory with needed items only -unused items will have to be discarded or resterilized

Patient awareness and what that involves

-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

Personal Protective Equipment (PPE)

-protect yourself against the risk of occupational exposure Ex) gloves, masks, eyewear, clinical clothing

What are some tasks that CDC does?

-review current scientific information and creates recommendations to protect the health of the population -Tracks disease trends and investigates disease outbreaks -Control spread of infection from workers to patients, patient to worker and between patients

Instrument Storage requirements

-should be packaged for storage -storage area should be clean, dry and closeable

Classification of hazardous waste generator: medical waste

-small quantity generator -Less than 50 lbs of regulated medical waste *most dental offices in this category*

What are some key factors for choosing disinfectant chemicals?

-staff/patient compatibly -Non toxic -Ease of use -User satisfaction -Shelf life -Disposal -Cost

What should be done when managing an exposure incident?

-take steps immediately, do not ignore the incident -detailed procedures are outlined in the Postexposure Management Plan

How can exposure occur?

-through blood, body fluids, or other potentially infectious materials -direct contact, indirect contact and/or spatter and aerosols

*clean and disinfect operatory* What is the purpose of cleaning? What cleansing agents are used?

-to reduce bioburden -water and detergent *more detergent or surfactant, better the breaking up of debris*

chemical inventory (chemical hazard communications program)

-updated as new chemicals are used and reviewed annually, should be accessible to all employees

What are utility gloves used for?

-used for handling contaminated sharps or chemicals -should be puncture or chemical resistant

What are over gloves used for?

-used for prevention of cross contamination -not used much in dental offices

What is included in a complete sterilization?

-warm up -20 min of sterlization -cool down

What to do with puncture wounds?

-wash with soap and water and control bleeding -Squeezing wound will *NOT* reduce risk of infection -Do not use bleach or disinfectants

The initial preparation of an operator involves what 3 steps:

1) Clean and disinfect the operatory 2) Barrier protection for the operatory 3) Plan treatment

What are the 5 main parts of the chemical hazard communications program?

1) Written program 2) Chemical inventory 3) SDS 4) Container labeling 5) Employee training

What are the steps for instrument processing cycle? 6 steps

1) instruments must be transported in a holding/transporting container from from operatory to sterilization 2) optional holding solution if not immediately cleaned 3) Ultrasonic cleaning 4) Instrument packaging/internal chemical monitoring/labeling 5) Sterilization process/mechanical monitoring/ biological monitoring 6) storage

What percentage of people are unaware of their HIV status?

20%

How long should water and air be discharged from any device connected to the water system that enters the mouth?

20-30 seconds

How many people are non-responders for Hep B immunization?

4-6% may not develop immunity

How many primary controls or protection methods are there?

5

What percentage of people are aware they have Hep B?

50%

How long can Hepatitis B Virus survive without a host?

7 days *more virulent than other viruses*

What percentage of Hep B patients do not show symptoms?

80%

What is a pathogen?

A disease causing agent

What are high-level disinfectants able to kill?

Ability to kill endospores, *TB*, hydrophilic and lipophilic viruses, fungi and vegetative bacteria when used according to the directions

What is the goal for surface disinfectants?

Achieve the highest level of disinfection possible

Skull and crossbones

Acute Toxicity (fatal or toxic)

How often should we discharged water and air from any device connected to the water system that enters the mouth?

After every patient

*clean and disinfect operatory* What items must be cleaned?

All surfaces and equipment that have the potential to become contaminated from hand contact, aerosols, spatter or other contaminated items

What does ADAA stand for?

American Dental Assisting Association

What does ADA stand for?

American Dental Association

What does ADHA stand for?

American Dental Hygiene Association

Hazardous waste

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

Environment (Non-Mandatory)

Aquatic toxicity

Exposure control manager

Assigned to manage the practice's training program and ensure documentation is properly maintained -responsible for paperwork (training, etc.)

What does APIC stand for?

Association for Professionals in Infection Control and Epidemiology

What are the different methods for instrument cleaning?

Automated or manual -Automated: ultrasonic cleaners which break up and loosen debris -Manual: hand scrubbing, many risks involved

What is the purpose of the holding solution?

Basically a soaking solution to prevent debris from drying on the instrument

How long does HIV survive outside the body at room temperature?

Blood containing HIV only survives outside the body while wet and for a period of half an hour or less

________ also requires maintenance of records of work related medical management.

CDC

What does CDHA stand for?

California Dental Hygiene Association

What can happen to gloves when used with petroleum-based lotions?

Can weaken *latex* gloves and increase permeability

Health hazard

Carcinogen Mutagenicity Reproductive Toxicity Respiratory Sensitizer Target Organ Toxicity Aspiration Toxicity

What does CDC stand for?

Centers for Disease Control and Prevention

How often should holding solution be changed?

Changed twice a day or more when visibly cloudy

*clean and disinfect operatory* What is required prior to disinfection?

Cleaning

Biofilm

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

Noncritical instruments and examples

Contacts intact skin Examples: radiograph head/cone, blood pressure cuff

Semi-critical instruments and examples

Contacts mucous membranes or non-intact skin Examples: mouth mirror, impression trays, dental handpieces

When should protective clothing be changed?

Daily or more if visually contaminated or wet and soaked through

_________ may be the first person to suspect or recognize symptoms of HIV in the mouth.

Dental healthcare workers

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 are the procedures for instrument processing?

Depends on the type of instrument and how it is used

Who does the CDC protect?

Designed to protect workers and patients

What does a low level disinfectant kill?

Destroys certain viruses and fungi but *not TB*

Why should training documentation occur and how long should it be kept?

Documentation is done to verify compliance -should be kept for 3 years

Chickenpox/Varicella Zoster and Flu/Influenza are spread through what?

Droplets *N95 recommended*

Use water that meets _______ regulatory standards for drinking water

EPA

_______ has jurisdiction over disposal unless state local regulations are more strict.

EPA

Hospital-level germicide

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

What does the hazard communication standard state?

Employees have a need and a right to know what chemicals are known to be present in their workplace

What does OSHA mandate?

Employees will be provided a safe environment free of hazards

Housekeeping surfaces

Environment surfaces that are not involved in the direct delivery of dental care

EPA

Environmental Protection Agency

Environmental Infection control

Environmental surfaces are either clinical contact or housekeeping

Is immunization effective for Hep B?

Extremely effective!

True or false: Proper personal hygiene is not necessary before putting on PPE's because gloves are worn

FALSE

True or false: Items that are frequently touch are required to have barrier protection

FALSE, they should be considered but are not required Examples: saliva ejector holders, tray handles, light switches, light handles, water syringe handle

Who regulates PPE's?

FDA

True or false: Hep C currently has a vaccine

False

True or false: PPE's do not have a shelf life.

False

True or false: The plastic tubing is frequently contaminated with small numbers of potentially pathogenic microorganism

False, Large numbers

True or false: Disengage a capped needle from a syringe by hand

False, NEVER do this

True or false: PPEs do not have be to used when cleaning and disinfecting the operatory

False, PPE's must be used

True or false: When a chemical is no longer in use, the SDS sheet is no longer needed.

False, SDS should go into separate binder and should be kept for up to 30 years after use

True or false: there are many documented cases of illness associated with exposure to contaminated water

False, There are few cases

True or false: SDS do not need to include household products brought from the office

False, a SDS should be made for those products too

True or false: The SDS sheet contains procedures for cleaning up chemical spills only.

False, also has first aid for that specific chemical

True or false: tap water must be used for autoclaves

False, distilled water

True or false: Packaging material may be re-used

False, do not re-use

True or false: You are able to make notes in the patients chart during treatment

False, don't make notes in the chart, charts cannot be contaminated

True or false: Only the hygienists and dentist should be able to discuss all aspects of your exposure control program with any patient.

False, everyone in the practice should be able to

True or false: The disposal of waste is a cheap process

False, expensive

True or false: The dental practice is responsible for waste until it is removed from the office.

False, is responsible for the waste until it is destroyed or rendered nonhazardous

True or false: Fulcrum on the same tooth are you working on

False, never do this

True or false: Recap a needle using two hands to ensure no injury

False, never recap a need with two hands

True or false: OSHA requires SDS to be in a consistent format

False, wants it to be in a consistent format to improve effectiveness

What two hazards contain self reactives?

Flame and explosives

Flame

Flammables Pyrophorics Self-Heating Emits Flammable Gas Self-Reactives Organic Peroxides

What are some examples of housekeeping surfaces?

Floors, walls, sinks, counter in front office

What is the instrument processing cycle?

Following treatment, instrument must go through a sterilization process in a safe and time efficient method

Gas cylinder

Gases under pressure

Plain vs antimicrobial soap (pink vs. green)

Green(antimicrobial): to be used at the beginning of the day and at the end of the day, also after lunch if left the office Plain (pink): to be used in between patients

Guidelines of OSHA were voluntary until when?

Guidelines were voluntary until HIV occured

If a disinfectant is able to kill TB, this means it also kills what?

HIV and HBV

Is risk of transmission after exposure higher for HIV, Hep B, or Hep C?

HIV is low for healthcare workers -Hep B and C are higher

What can harbor high levels of microorganisms? (on provider)

Hair, fingernails and jewelry

Oral surgical procedures requires what?

Hand antisepsis

The _____ are the most common mechanism of transporting contamination

Hands

hand washing and gloves

Handwashing must precede gloving and follow removal

All dental offices generate _____ and ____ waste.

Hazardous and general

What does HIPAA stand for and what does it do?

Health Insurance Portability and Accountability act -Protects patient's privacy

What is the most effective method of sterilization? Combined with what makes it more effective?

Heat sterilization -combined with steam or unsaturated chemical vapor under pressure

What is the benefit of chemical labeling?

Helps to avoid hazards or potential hazards

Hep B immunization also protects against what?

Hep D

What is the most common occupational disease acquired in a dental setting? How is it transferred?

Hepatitis B -transferred through saliva

What are blood borne pathogens of primary concern?

Hepatitis B(HBV), Hepatitis C(HCV), and HIV

When should contaminated instruments be transported to the sterilization area? What should be worn?

Immediately after treatment is complete -Appropriate PPE's and utility gloves

What is an example of a high-level disinfectant?

Immersion high-level disinfection or immersion sterilization

Where do all non reusable sharps get disposed?

In a sharps container

Who does the CDC govern?

In the United States

What is classified as hazardous?

Infectious, chemical, or physical (sharps), or any combination of these

Hepatitis C is know for people that use what?

Intravenous drugs

What to do when splashes get into the eye?

Irrigate with clean water, saline, or sterile solution

Exclamation Mark

Irritant (skin and eye) Skin Sensitizer Acute Toxicity (harmful) Narcotic Effects Respiratory Tract Irritant Hazardous to Ozone Layer (Non-Mandatory

Why is hepatitis B a major concern in the office?

It is smaller than the pore in gloves

What is a common symptom for any type of hepatitis?

Juandice

What are some examples of clinical contact surfaces?

Light handles, dental radiograph equipment, faucet handles, pens, doorknobs, switches, dental chair side computers, countertops

Hepatitis B causes inflammation where?

Liver

What are utility gloves made of?

Made of many materials, depends on needs

How is exposure risk measured?

Made without consideration to PPE's used

Hospital level disinfectants

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

A _______ mask should be used if performing dental treatment on a TB patient.

N-95

Sharps Safety And The Needle-stick Prevention Act

New devices used for needle-stick 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 Hep C a huge risk for healthcare workers?

No

Is there an immunization for HIV?

No

What is step number two for managing an exposure incident?

Notify the exposure control manager

When can a new label be used for a chemical?

ONLY applies when product is removed from the original container -Must contain same info as original

If a workplace incident occurs that resulted in a fatality or hospitalization of 3 or more employees, the office must report to who?

OSHA

What does OSHA stand for?

Occupational Safety and Health Administration

CDC guidelines for Infection control in dental healthcare setting 2003

Only sterile fluids should be used for procedures in which bone is exposed -Mostly for periodontal and oral surgery procedures -requires a sterile disposable or sterilizable water delivery system

What does OSAP stand for?

Organization for Safety, Asepsis and Prevention

Who regulated the transportation and disposal of infectious water after if leaves the dental office?

Other federal, state and local authorities

Describe the TB particles

Particles are extremely small in size and normal air currents can keep them airborne for prolonged time periods

latent tuberculosis infection

Patients usually have no symptoms but have a positive purified protein derivative (PPD) test -cannot infect others, not active

Critical instrument definition and example

Penetrates soft tissue, contacts bone, enters into or contacts the bloodstream or other normally sterile tissue Examples: surgical instruments, periodontal scalers

What can be done if an infectious non sharps bag is leaking?

Place in another bag

The ability of an organism to infect and cause disease depends on both the ______ and ______.

Potential host and infecting agent

Transmission-based precautions

Precautions for infection prevention in the care of patients who are infected with highly contagious pathogens spread through airborne, droplet or contact route

What should meet American National Standards Institute (ANSI) criteria?

Protective eyewear

What is the purpose of packaging instruments?

Provides a barrier for instruments after sterilization, should be labeled

What kind of container should be used to carry instruments to sterilization?

Puncture resistant, leakproof with solid sides and bottom and has a biohazard label, lid would be valuable

What is the purpose of OSHA?

Purpose of protecting the health and safety of all workers (employees only)

What is required for on-site treatment of waste or by the hazardous waste disposal company?

Records or documentation

What is required on the chemical labels by the hazard communication standard?

Required to have a pictogram, signal word, hazard statement, and precautionary statement

Where are the workplace emergency procedures found?

Should be covered in the comprehensive procedure plan

Hair requirements while working

Should be pulled back from the face and pinned without hanging on either side the face or neck

Employee training (chemical hazard communications program)

Should have training in all 5 parts of the program

How long should a disinfectant take to kill TB?

Should take less than 10 mins

What medication is used to help treat Hep C?

Sovaldi

Generators of waste must follow _______ regulations for transportation and disposal.

State

Many regulations that control the disposal of waste are at the ____ level, which are more stringent than ____ mandates.

State, federal

What can cause a compromised immune system?

Stress, bad diet, lack of sleep

______ may be hired for proper transportation and disposal.

Subcontractor

Toxic waste

Subset of hazardous waste -capable of having a poisonous effect

Clinical contact surfaces

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

True or false: Employees must have some general knowledge of chemical handling, safety and emergency response in the event of an exposure or spill in, specific to their job duties

TRUE

Hep B is an epidemic in many area of the world but not ________.

The US

Classification of hazardous waste generators depends on?

The amount generated in each category per month

Disinfection

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

What are controls?

The process of reducing on the job risks

Sterilization

The process that completely destroys all microbial life, including spores.

What can occur if the sterilizer is overloaded?

There may be packages with cold spots, which can result in incomplete sterilization

Parenteral contact

Through the skin

What is the first step in managing an exposure incident?

Treat and contain injury -Puncture wounds -Splashes in eyes -Splashes to non intact skin

True or false: All post-exposure evaluations and requirements must be made available to the employee at a reasonable time and place and at no cost to the employee, and performed by a licensed healthcare professional

True

True or false: Anything at risk for contamination in the operatory must be barrier protected

True

True or false: Cleaning and disinfecting may be done with one product

True

True or false: Don't answer the phone during treatment

True

True or false: OSHA requires employers to be responsible for laundering of reusable protective clothing

True

True or false: Open packaged instruments in front of patients

True

True or false: Protective eyewear must be cleaned with soap and water or clean and disinfected for visible soil

True

True or false: SDS must have required specified headings in a specified sequence

True

True or false: Surface disinfectant but be registered with EPA, this means it has completed minimum scientific testing.

True

True or false: There is a potential sensitivity to material of PPE's

True

True or false: employees must be prepared for any foreseeable emergency

True

True or false: moisture from the steam heat under pressure may cause corrosion on certain products

True

True or false: never pass sharps in a manner that might cause injury

True

True or false: remove gloves prior to leaving the operatory and perform hand hygiene

True

True or false: Don't touch your hair, mask or eyewear

True -Don't touch anything that is not essential for patient treatment

True or false: extracted teeth may be returned to the patient

True, ONLY if the tooth does not have amalgam

True or false: regulated non sharp medical waste may be sterilized in-house to render it non-infectious and then disposed of with general waste

True, allowed in some states

True or false: OSHA may request copies of OSHA training records.

True, also why it is important to document it

True or false: Infectious waste must be handled and disposed of as biological hazard (biohazard)

True, may be costly, appropriate segregation is important

True or false: Never wipe debris from an instrument with gauze

True, risk of getting cut

True or false: gauze may be placed around sharp instruments

True, to prevent piercing of the package

True or false: Don't reach inside a cabinet for supplies during treatment

True, use forceps or over gloves if necessary

universal vs standard precautions

Universal precautions: Treat all blood and body fluids as if they were infectious, protects workers Standard precautions: expands upon universal precautions, protect both healthcare workers and patients, *stricter*

When is a low level disinfectant used?

Used for general housekeeping and clinical contact surfaces not contaminated with blood

When is holding solution used?

Used if instruments cannot be cleaned immediately after patient treatment -not necessary if instruments cleaned soon after use

When are high level disinfectants used?

Used to disinfect semicritical items that cannot withstand heat or ethylene oxide sterilization

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

What type of gloves are able to be sanitized?

Utility gloves

Agent

Virulence and amount transmitted (dosage) determines ability to infect you

Virus vs bacteria

Virus- smallest of all microorganisms, vaccines, *need host*, antibiotics will not work for a virus Bacteria- do not need a host, have cell walls that antibiotics are able to break down

When does cross contamination/cross infection occur?

When you, or your patient, have an infection and that infection is passed alone to staff members, family, or friends

*barrier protection for the operatory* Are barrier preferred over disinfectants? why?

Yes, because they reduce exposure to chemical and save time in operatory processing

Do you have the right to refuse Hep B immunization?

Yes, but ONLY after hearing the safety and efficacy and potential risk of refusal

How is TB spread?

airborne particles known as droplet nuclei

What does sterilization destroy?

all microbial forms including bacterial endospores

Bioburden

amount of biological or organic material, such as blood and saliva, on a surface

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 -not used intramurally*

What is an infectious disease?

anything that causes disease

Thrush is commonly seen in

babies

What causes tuberculosis (TB)?

bacterium M. tuberculosis

How is HIV transmitted?

bodily fluids

What type of covers are best to use as barriers?

commercial medical surface covers are best to use

Examples of noncritical surfaces

counter in operatory

What does the shelf life depend on?

depends on the integrity of the packaging material and storage environment

droplet nuclei

droplets of respiratory secretions from an infected individual when he coughs, laughs, or sneezes

True or false: proper seal is not super important for a face mask

false

True or false: gloves can be used for multiple patients

false, single use and must be changed between patients

Thrush

fungal infection of the mouth -Painful -wipeable

Chemical sterilants

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

*clean and disinfect operatory* When is a barrier used?

if a surface cannot be cleaned and a disinfectant will not work

In what position should hinged instruments be packaged?

in the open position

Use of barriers is for protection of ______ and ______.

infectious agents and chemicals

contact dermatitis

irritated or allergic response of the skin that can lead to an acute or chronic inflammation

Using hand cream at the end of the day is beneficial because?

it will reduce dryness that can cause microabrasion and susceptibility to exposure

*barrier protection for the operatory* For what items are barriers used? examples?

items that cannot be effectively cleaned and disinfected Examples: ridges, grooves, switches, electrical components

Mustaches and beard requirements while working

neatly trimmed to be covered by a mask

Face masks should not be worn on?

neck, head or hair, or carried by hand

Flame over circle

oxidizers

Best option for transmission

prevent infection in the first place through controls

How is hep C spread?

primarily through blood contact, sexual transmission or pregnancy

Face shields should protect what?

should have crown and chin protection and wrap around the face to the point of the ear

What must be indicated on the label of a disinfectant? What phrases indicate this?

the amount of time it takes to kill TB -Tuberculocidal -Intermediate-level surface disinfectant -Hospital-level disinfectant

Microbial dose load

the dose load of microorganisms present in a specific area

Alcohol-based hand rub may be used unless

the hands are visibly soiled

Low level disinfectants

the major source of products used in households, swimming pools and water purifiers *not used in dental offices*

All chemical contained must be labeled with what?

the same label that would be on shipped containers for the chemical or with alternative labels that meet the requirements for the standard

Method used for hand washing depends on

the type of procedure to be performed and the degree of contamination

Records kept of dental waste is determined by?

the type of waste generated

Face masks are effective until when?

they become wet

Working in dentistry puts you at risk of potential exposure incidents in how many areas? What are they?

three: infectious, chemical and physical -Same hazards may be present in dental waste

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: First aid equipment must be kept with updated contented and checked for proper working order and expiration dates

true

True or false: SDS should be accessible to all employees

true

True or false: you may place your mask on a paper towel in operator to walk out

true

What are patient examination gloves used for?

used for patient care, examinations, other nonsurgical procedures involving contact with mucous membranes and laboratory procedures *non-sterile and single-use*

*barrier protection for the operatory* Why are barriers used?

used to isolate surfaces with a covering, not as a replacement for cleaning

Standard precautions for PPE

using universal precautions with obligation to protect the dental team and patients from pathogens

What to do when splashes to intact skin occurs?

wash with soap and water

Most diseases associated with ______ affect the gastrointestinal system.

water *water quality used in dental treatment is of concern*

When should gloves be worn?

whenever there is a potential to come in contact w/ blood, saliva, mucous membranes, hazardous or infectious wastes, or chemical agents

What is latent TB?

within 2-10 weeks of infection, the body's immune system will respond and prevent it from further multiplication and spreading