Sterilization and Disinfection of Patient/care Items in Oral Healthcare Settings

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

A. Heat-tolerant semi-critical items such as handpieces must minimally undergo high-level disinfection with an FDA-registered chemical sterilant used as a high level disinfectant.

All of the following statements are correct with respect to the various quality assurance indicators of the sterilization process, EXCEPT for one. Which one is the exception? A. Monitoring physical indicators involves observing the gauges or displays on the sterilizer and recording the time, temperature, and pressure associated with each sterilization cycle for each load. B. Chemical indicators use sensitive chemicals to assess critical variables (i.e., time, temperature, steam saturation) during a sterilization cycle and validate that sterilization has been achieved. C. Biological indicators (BIs), or spore tests, assess directly the killing of known highly resistant, nonpathogenic bacterial spores. D. The results of physical, chemical and biological monitoring must be documented in a sterilization monitoring record.

B. Chemical indicators use sensitive chemicals to assess critical variables (i.e., time, temperature, steam saturation) during a sterilization cycle and validate that sterilization has been achieved.

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

B. Heat-sensitive semi-critical items must minimally undergo high-level disinfection, i.e., they must be immersed in an FDA-registered chemical sterilant, but for a shorter contact time (≤12 min.).

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

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

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

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

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

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

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

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

All of the following statements related to critical or semi-critical, or non-critical patient-care items are correct EXCEPT for one. Which one is the exception? A. Heat-tolerant critical patient-care items confer a high degree of risk for infection if contaminated with pathogens and must be sterilized by a U.S. Food and Drug Administration (FDA)-cleared heat sterilizer. B. Heat-tolerant semi-critical patient-care items, including all dental handpieces, must be heat sterilized. C. Heat-sensitive critical items must minimally undergo intermediate-level disinfection using an FDA-registered chemical sterilant. D. Unless visibly soiled, for non-critical items disposable barrier protection is the preferred infection control method during their use

C. Heat-sensitive critical items must minimally undergo intermediate-level disinfection using an FDA-registered chemical sterilant.

All of the following statements are correct with respect to procedures to follow in the event of a positive spore test, EXCEPT for one. Which one is the exception? A. In case of a positive spore test, the sterilizer should be removed from service and all records of physical and chemical monitoring since the last negative BI test should be reviewed. B. If the physical and chemical indicators demonstrate that the sterilizer is functioning correctly consider the possibility of operator error, using the same cycle that produced the failure, repeat the spore test immediately after correctly loading the sterilizer. C. If packaging, loading, and operating procedures have been confirmed as performed correctly and the repeat BI test is negative, the sterilizer must remain out of service until it has been inspected, repaired, and re-challenged with a confirmatory BI test. D. All items sterilized from suspect loads dating back to the last negative BI test should be re-cleaned, wrapped, and re-sterilized

C. If packaging, loading, and operating procedures have been confirmed as performed correctly and the repeat BI test is negative, the sterilizer must remain out of service until it has been inspected, repaired, and re-challenged with a confirmatory BI test.

All of the following statements are correct with respect to processing contaminated reusable patient-care items, EXCEPT for one. Which one is the exception? A. There should be a central processing area (CPA) of adequate size with four successive stations for (1) receiving and cleaning; (2) preparation and packaging; (3) sterilization or disinfection; and (4) storage of sterilized units. B. Within the CPA, each station should be physically separated to control traffic flow and to contain contaminants during the process. C. If physical separation between stations is not practical, barriers must be installed to isolate the stations. D. Reusable contaminated patient-care items must be transported from the point of use to the CPA in sealed, leak proof containers displaying a biohazard symbol.

C. If physical separation between stations is not practical, barriers must be installed to isolate the stations.

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

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

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

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

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

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

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

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

All of the following statements pertain to Spaulding's approach to sterilization and disinfection, EXCEPT for one. Which one is the exception? A. During the course of their intended use, critical items penetrate soft and hard sterile tissues or the vascular system. B. During the course of their intended use, semi-critical items contact, but do not penetrate nonintact skin or mucous membranes. C. During the course of their intended use, non-critical items come in contact with intact skin, but not mucous membranes. D. During the delivery of care, the most important factor determining the risk of infection from contaminated instruments is the duration of exposure.

D. During the delivery of care, the most important factor determining the risk of infection from contaminated instruments is the duration of exposure.

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

D. Once the sterilization cycle is complete, remove the packs to cool and dry outside the chamber.

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

D. The static-air type has the advantage a shorter sterilization cycle time compared to the forced-air type.

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

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

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

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

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

D. Bacillus atrophaeus spores are used to steam sterilizers