Infection Control, Sterilization, & CDC
How are pathogenic microorganisms like HBV transmitted in the dental setting?
1) direct contact with blood, oral fluids, or other patient materials; 2) indirect contact with contaminated objects (e.g., instruments, equipment, or environmental surfaces); 3) contact of conjunctival, nasal, or oral mucosa with droplets (e.g., spatter) containing microorganisms generated from an infected person and propelled a short distance (e.g., by coughing, sneezing, or talking); and 4) inhalation of air- borne microorganisms that can remain suspended in the air for long periods
When is it appropriate to use unwrapped sterilization methods and what conditions must occur?
An unwrapped cycle (sometimes called flash sterilization) is a method for sterilizing unwrapped patient-care items for immediate use. Unwrapped sterilization should be used only under certain conditions: 1) thorough cleaning and drying of instruments precedes the unwrapped sterilization cycle; 2) mechanical monitors are checked and chemical indicators used for each cycle; 3) care is taken to avoid thermal injury to DHCP or patients; and 4) items are transported aseptically to the point of use to maintain sterility.
Why and when do we have our patients use an antimicrobial mouthrinse?
Antimicrobial mouth rinses used by patients before a dental procedure are intended to reduce the number of microorgan- isms the patient might release in the form of aerosols or spat- ter that subsequently can contaminate DHCP and equipment operatory surfaces.
Why do we use barriers?
Barrier protection of surfaces and equipment can prevent contamination of clinical contact surfaces, but is particularly effective for those that are difficult to clean.
Why are you to wear a mask and nitrile gloves when disinfecting your operatory?
Because of the risks associated with exposure to chemical disinfectants and contaminated sur- faces, DHCP who perform environmental cleaning and disinfection should wear gloves and other PPE to prevent occupational exposure to infectious agents and hazardous chemicals.
How do you manage barriers between patients?
Because such coverings can become contaminated, they should be removed and discarded between patients, while DHCP are still gloved. After removing the barrier, examine the surface to make sure it did not become soiled inadvertently. The surface needs to be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers on these surfaces before the next patient.
yes because they are not DHCP and don't come into contact with blood
Can an individual that is a carrier of Hepatitis B work as a dental receptionist? Why or why not?
Yes. This virus is not transmitted efficiently through occupational exposures to blood
Can an individual with Hepatitis C work as a dental hygienist? Why or why not?
What are the predisposing factors/conditions to alert us that a patient may have a latex sensitivity/allergy?
Certain common predisposing conditions for latex allergy include previous history of allergies, a history of spina bifida, urogenital anomalies, or allergies to avocados, kiwis, nuts, or bananas.
What is the receiving, cleaning, & decontaminated procedure for managing contaminated dental instruments?
Cleaning should precede all disinfection and sterilization processes; it should involve removal of debris as well as organic and inorganic contamination. Removal of debris and contamination is achieved either by scrubbing with a surfactant, detergent, and water, or by an automated process (e.g., ultrasonic cleaner or washer-disinfector) using chemical agents. If visible debris, whether inorganic or organic matter, is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process. After cleaning, instruments should be rinsed with water to remove chemical or detergent residue. Splashing should be minimized during cleaning and rinsing. Before final disinfection or sterilization, instruments should be handled as though contaminated.
What is Creutzfeldt-Jacob disease and why is of concern to dentistry?
Creutzfeldt-Jakob disease (CJD) belongs to a group of rap- idly progressive, invariably fatal, degenerative neurological dis- orders, transmissible spongiform encephalopathies (TSEs) that affect both humans and animals and are thought to be caused by infection with an unusual pathogen called a prion. Prions are isoforms of a normal protein, capable of self-propagation although they lack nucleic acid. Prion diseases have an incu- bation period of years and are usually fatal within 1 year of diagnosis.
Is it okay to store your scaling instruments unwrapped? Why?
Critical instruments sterilized unwrapped should be transferred immediately by using aseptic technique, from the sterilizer to the actual point of use. Critical instruments should not be stored unwrapped. Semicritical instruments that are sterilized unwrapped on a tray or in a container system should be used immediately or within a short time. When sterile items are open to the air, they will eventually become contaminated. Storage, even temporary, of unwrapped semi-critical instruments is discouraged because it permits exposure to dust, airborne organisms, and other unnecessary contamination before use on a patient
When do you need to change your overgown?
DHCP should change protective clothing when it becomes visibly soiled and as soon as feasible if penetrated by blood or other potentially infectious fluids
"Unless contamination is reasonably anticipated or apparene, cleaning or disinfecting walls, window drapes, and other vertical surfaces is unnecessary."
Do you need to clean the wall in your operatory? Do you need to clean the cabinet surfaces (vertical surfaces)?
A one-handed scoop technique (or a mechanical device designed for holding the needle cap to facilitate one-handed recapping, or an engineered sharps injury protection device)
Dr. Pearce just provided a local anesthesia injection and turned over the used syringe to you, how are you going to recap the contaminated needle?
What is the difference between a clinical contact surface and a housekeeping surface?
Environmental surfaces can be divided into clinical contact surfaces and housekeeping surfaces (249). Because housekeep- ing surfaces (e.g., floors, walls, and sinks) have limited risk of disease transmission, they can be decontaminated with less rig- orous methods than those used on dental patient-care items and clinical contact surfaces (244). Strategies for cleaning and disinfecting surfaces in patient-care areas should consider the 1) potential for direct patient contact; 2) degree and frequency of hand contact; and 3) potential contamination of the sur- face with body substances or environmental sources of micro- organisms (e.g., soil, dust, or water).
What is regulated waste and have you experienced it in Clinic I?
Examples of regulated waste found in dental-practice settings are solid waste soaked or saturated with blood or saliva (e.g., gauze saturated with blood after surgery), extracted teeth, surgically removed hard and soft tissues, and contaminated sharp items (e.g., needles, scalpel blades, and wires) and No
What is the cause of occupational exposures to blood in dentistry that poses the greatest risk of disease transmission?
Exposures occur through percutaneous injury (e.g., a needle-stick or cut with a sharp object), as well as through contact between potentially infectious blood, tissues, or other body fluids and mucous membranes of the eye, nose, mouth, or non-intact skin (e.g., exposed skin that is chapped, abraded, or shows signs of dermatitis)
Is it okay to give your patient their extracted 3rd molar?
Extracted teeth can be returned to patients on request, at which time provisions of the standard no longer apply
Is it okay to use a "bead sterilizer" in dentistry? Why?
FDA has determined that a risk of infection exists with these devices because of their potential failure to sterilize dental instruments and has required their commercial distribution cease unless the manu- facturer files a premarket approval application.
Is it acceptable to disinfect your prophy angle handpiece (instead of placing it through a sterilization cycle)?
For processing any dental device that can be removed from the dental unit air or waterlines, neither surface disinfection nor immersion in chemical germicides is an acceptable method.
When is nail polish okay?
Freshly applied nail polish on natural nails does not increase the microbial load from periungual skin if fingernails are short; however, chipped nail polish can harbor added bac- teria
Given the scenario that you have chicken pox, when can you return to work as a dental hygienist?
From tenth day after first exposure through twenty-first day (twenty-eighth day if varicella-zoster immune globulin [VZIG] administered) after last exposure.
never
Given the scenario that someone received the primary vaccine series for HBV and they responded accordingly with antibodies, how often should they receive a booster does of the vaccine?
They should be tested to determine if they are HBAg positive. (If positive, they are counseled regarding how to prevent HBV transmission and the need for medical evaluation. If negative, they should be considered susceptible to HBV infection)
Given the scenario that someone received the primary vaccine series for HBV, what should they do if they are a nonresponder to the vaccination?
complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive
Given the scenario that someone received the primary vaccine series for HBV, what should they do if they did not develop an adequate antibody response?
until all lesions dry and crust
Given the scenario that you have chicken pox, when can you return to work as a dental hygienist?
What are the infection control procedures during obtaining and exposing radiographs/digital plates?
Gloves should be worn when taking radiographs and handling contaminated film packets. Other PPE (e.g., mask, protective eyewear, and gowns) should be used if spattering of blood or other body fluids is likely. Heat-tolerant versions of intraoral radiograph accessories are available and these semicritical items (e.g., film-holding and positioning devices) should be heatsterilized before patient use.
Why should you not wear artificial nails, even if kept short?
Hand carriage of gramnegative organisms has been determined to be greater among wearers of artificial nails than among non-wearers
What is the single most critical measure for reducing the risk of transmitting disease?
Hand hygiene (e.g., handwashing, hand antisepsis, or surgi- cal hand antisepsis) substantially reduces potential pathogens on the hands and is considered the single most critical mea- sure for reducing the risk of transmitting
When do you need to wash your hands in terms of glove use? What water temp?
Hand hygiene should be performed immediately before donning gloves. In addition, bacteria can multiply rapidly in the moist environments underneath gloves, and thus, the hands should be dried thoroughly before donning gloves and washed again immediately after glove removal. cool or tepid water is recommended
direct contact indirect contact droplets aerosol
How are pathogenic microorganisms like HBV transmitted in the dental setting?
they are to be thoroughly cleaned, disinfected with tuberculocidal disinfectant, and thoroughly rinsed
How are you to manage a dental impression before taking it to the materials lab to pour up your model?
clean with soap and water, and when visibly soiled, disinfected between patients
How are you to manage your face shields/protective eyewear
After removing barrier, examine surface to make sure it did not become soiled. (Surface cleaned and disinfected if soiled) If not, remove gloves and wash hands and place clean barriers before next patient
How do you manage barriers between patients?
at least 1 week
How long can HBV survive in dried blood at room temperature on an environmental surface?
duration of employment plus 30 years
How long is your dentist-employer required to keep your confidential medically related information?
early detection and prompt isolation from susceptible persons is the goal. Patients with history or symptoms indicative of TB should be referred for medical evaluation. The pt should not remain in the dental care facility any longer than required to evaluate their condition and arrange a referral. Pt should be isolated, wear a surgical mask. Elective dental tx deferred until pt is determined not to have infectious TB or until the patient is no longer infectious. If urgent dental care is needed, the care should be provided at a hospital or facility that provides airborne infection isolation
How should we handle a patient suspected infected with TB?
they should covered with barriers that are changed after each use
How should you manage the handpiece coupling that remains in your operatory?
What should you do if you are working the sterilization center and you notice that a "sterilized" instrument packet is torn?
If packaging is compromised, the instruments should be cleaned, packaged in new wrap, and sterilized again.
no
If your hands are visibly soiled, is it acceptable to use an alcohol-based hand rub?
-your name -emergency location -nature of emergency -send someone to meet ambulance -stay on line
In the emergency protocal, if 911 is called, what information is to be provided to the operator and steps to be followed
dental health care personnel
In the text the acronym DHCP is used - what does it reference?
Other Potentially Infectious Materials
In the text the acronym OPIM is used - what does it reference?
Why should you allow the instrument packs to dry in the sterilizer before removing them?
Instrument packs should be allowed to dry inside the sterilizer chamber before remov- ing and handling. Packs should not be touched until they are cool and dry because hot packs act as wicks, absorbing moisture, and hence, bacteria from hands.
What is the difference between irritant contact dermatitis and allergic contact dermatitis
Irritant contact dermatitis is com- mon, nonallergic, and develops as dry, itchy, irritated areas on the skin around the area of contact. By comparison, allergic contact dermatitis (type IV hypersensitivity) can result from exposure to accelerators and other chemicals used in the manu- facture of rubber gloves (e.g., natural rubber latex, nitrile, and neoprene), as well as from other chemicals found in the dental practice setting (e.g., methacrylates and glutaraldehyde).
No "for processing any dental device that can be removed from the dental unit air or water lines, neither surface disinfection nor immersion in chemical germicides is acceptable"
Is it acceptable to disinfect your prophy angle handpiece (instead of placing it through a sterilization cycle)?
Yes, if they request it
Is it okay to give your patient their extracted 3rd molar?
No. When sterile items are open to the air, they eventually become contaminated. (It permits exposure to dust, airborne organisms, and other unnecessary contamination)
Is it okay to store your scaling instruments unwrapped? Why?
No. The FDA has determined that risk of infection exists because of their potential failure to sterilize instruments
Is it okay to use a "bead sterilizer" in dentistry? Why?
Yes, it is stored in a closed container (not topped off) and is dispensed hands-free
Is our liquid soap dispensing system the ideal? Why or why not?
-wash injured area -report to faculty -within 1 hour, follow accident procedure in handbook -IF POST CARE NEEDED -source person and student should have blood drawn -student is to seek care according to ACC policies -source person and student to take ACC insurance and HIPAA forms with them
List ACC needlestick protocal
-relock emergency cart, cabinets etc -log off computers (sterilization room, computer study, dark room) -turn off scanners -return keys to hooks -give day sheet to faculty -ensure all autoclaves and fans are off
List finishing steps after instruments are run
-place foot controls on ground and store mesh -wash hands (15/10) -turn on master switch, shut down computer, launch eaglesoft, sign into messenger -ICX tab in bottle, fill with water -remove items from cabinet that need to be disinfected (pens, container, glasses) -don PPE (gown, mask, eyewear, gloves) -wipe housekeeping surfaces -wipe clinical contact surfaces 2X -wash hands (15/10) (NO GLOVES CONTINUING) -flush water lines 20 seconds -get out patient care packet -insert tips onto unit -apply barriers -obtain all other patient supplies -prepare patient mouthrinse
List in order the steps for op setup
-don PPE -keep all cassettes in white bins until designated time -load cassettes at 11:30 am and 4:30 pm -ensure spray arms can rotate -turn unit on, close door, select program 1 VARIO TD dental cycle, press start
List instructions for loading miele
-don PPE (gown, mask, glasses) -wash hands (15/10) -don gloves
List steps for beginning patient care
-activate red flashing light -notify student neighbor to get DDS and cart -stay with patient and begin assessment -faculty assesses patient and either call 911 or manage and monitor situation
List steps for emergency protocal
-with bare hands -load autoclave with cassettes standing on end -ensure reservoir is filled with water -close and lock door, select pouches and start -allow cassettes to dry 10 minutes, remove using hot mitts -place cassettes on wire racks to complete drying
List steps for loading autoclave
-don PEE -at designated time, load miele -put small items in ultrasonic (15), remove, rinse, drain -run handpieces through assistina -wash hands -date and label sterilization bag -don one utility glove and bag cassettes -remove glove and place indicator strip (if needed) into bag, date, label, seal, place in bin -don utility gloves, wash dry and place in bag, date, sign, glove size, seal -load autoclave -don gloves, empty white bins -disinfect counters, sink, faucet, anything else
List steps for running instruments
-with NO gloves, open cabinets -check for fire extinguisher, fire blanket, eyewash station -unlock: medical emergency cart, first aid kit, reference book cabinets, OH aids cabinets etc -log on all computers in dark room and sterilization room -position vital signs monitors, ensure anesthesia monitors are full -turn on master switches for clinic (water, vacuum, compressor) -don PPE -IF DATE IS NEAR 1st or 15th: replace soap and disinfecting solution (sterilization room, clinic, materials lab) and initial calendar -prepare ultrasonic solution -fill both white bins with water, put in dirty window -put empty red bin in dirty window -check statim waste bottle -check autoclave water levels -empty disinfector, package and run instruments -start water distiller -perform maintenance tasks (check equipment maintenance schedule/calendar) -prepare/read bio indicators -check cold sterile solutions (remove, rinse dry and stock any instruments that are ready)
List steps for sterilization room setup
If your hands are visibly soiled, is it acceptable to use an alcohol-based hand rub?
No
Can an individual with Hepatitis C work as a dental hygienist?Why or why not?
No restrictions on professional activity.HCV-positive health-care personnel should follow aseptic technique and standard precautions.
Given the scenario that you received the primary vaccine series for HBV, what should you do if you are a nonresponder to the vaccination?
Nonresponders to vaccination who are HBsAg-negative should be considered susceptible to HBV infection and should be counseled regard- ing precautions to prevent HBV infection and the need to obtain HBIG prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood.
In the text the acronym OPIM is used - what does it reference?
Other potentially infectious materials. OSHA term that refers to 1) body fluids including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures; any body fluid visibly contaminated with blood; and all body fluids in situations where differentiating between body fluids is difficult or impossible; 2) any unfixed tissue or organ (other than intact skin) from a human (living or dead); and 3) HIV-containing cell or tissue cultures, organ cultures; HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimen- tal animals infected with HIV or HBV.
How should we handle a patient suspected infected with TB?
Patients with a medical history or symptoms indicative of undiagnosed active TB should be referred promptly for medical evaluation to determine possible infectiousness.
Why should hand antiseptic products have a persistent effect?
Persistence is critical because microorganisms can colonize on hands in the moist environment underneath gloves
What does PPE stand for and entail?
Personal protective Equipment is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of DHCP from exposure to blood or OPIM. Primary PPE used in oral health-care settings includes gloves, surgical masks, protective eyewear, face shields, and protective clothing (e.g., gowns and jackets).
What are the various ways to assess if your sterilizer is working properly and what is the most accepted method?
Physical and chemical indicators. Biological indicators (BIs) (i.e., spore tests) are the most accepted method for monitoring the sterilization process (278,279) because they assess it directly by killing known highly resistant microorganisms (e.g., Geobacillus or Bacillus species), rather than merely testing the physical and chemical condi- tions necessary for sterilization.
How are you to manage your face shields/protective eyewear
Reusable PPE (e.g., clinician or patient protective eyewear and face shields) should be cleaned with soap and water, and when visibly soiled, dis-infected between patients, according to the manufacturer's directions.
What is the difference between universal precautions and standard precautions in the clinical dental practice?
Standard precautions apply to contact with 1) blood; 2) all body fluids, secretions, and excretions (except sweat), regard- less of whether they contain blood; 3) nonintact skin; and 4) mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between universal precautions and standard precautions.
all body fluids (except sweat) regardless of whether they contain blood nonintact skin mucous membrances
Standard precautions expand on universal precautions. Universal precautions indicated that you should treat all blood and body fluids that might be contaminated with blood as infections. Standard precautions includes these, as well as:
Why should you not let your patient close his/her mouth around the saliva ejector "like a straw"?
Studies have reported that backflow in low-volume suc- tion lines can occur and microorganisms be present in the lines retracted into the patient's mouth when a seal around the saliva ejector is created.
How should you manage the handpiece coupling that remains in your operatory?
Such components (e.g., handles or dental unit attachments of saliva ejectors, high-speed air evacuators, and air/water syringes) should be covered with impervious barriers that are changed after each use.
Why is there a concern over biofilm in the dental unit water lines?
These microorganisms colonize and replicate on the interior surfaces of the waterline tubing and form a biofilm, which serves as a reservoir that can amplify the number of free-floating (i.e., planktonic) microorganisms in water used for dental treatment. These exhibit limited patho- genic potential for immunocompetent persons.
Why do we date and initial the sterilization packages?
This approach recognizes that the product should remain sterile indefinitely, unless an event causes it to become contaminated
Why should you run a dental handpiece that uses water 20-30 seconds after the dental procedure has been completed?
This procedure is intended to help physically flush out patient material that might have entered the turbine and air and waterlines.
all blood and body fluids that might be contaminated with blood
Universal Precautions were based on the concept that _____ should be treated as infectious
Do you need to clean the wall in your operatory? Do you need to clean the cabinet surfaces (vertical surfaces)?
Unless contamination is reasonably anticipated or apparent, cleaning or disinfecting walls, window drapes, and other vertical surfaces is unnecessary.
Given the scenario that you received the primary vaccine series for HBV and you responded accordingly with antibodies, how often should you receive a booster does of the vaccine?
Vaccine-induced antibodies decline gradually over time, and 60% of persons who initially respond to vaccination will lose detectable antibodies over 12 years. Even so, immunity continues to prevent clinical disease or detectable viral infection. Booster doses of vaccine and periodic serologic testing to monitor antibody concentrations after completion of the vaccine series are not necessary for vaccine responders
Why should you not wash your gloves?
Washing latex gloves with plain soap, chlorhexidine, or alcohol can lead to the formation of glove micropunctures (177,212,213) and subsequent hand contamination
gloves worn, other PPE worn if spattering is likely. If barrier pouches are used, the packets should be carefully removed from the pouch to avoid contamination of the outside film packet.
What are the infection control procedures during obtaining and exposing radiographs/digital plates?
history of allergies, history of spina bifida, urogenital abnormalities, allergies to avocados, kiwis, nuts, or bananas
What are the predisposing factors/conditions to alert us that a patient may have a latex sensitivity/allergy?
-2 gallons + 4 cups water -2 1/4 ounces dentazyme
What are the proportions of water to dentazyme used
mechanical techniques, chemical indicators, multiparameter chemical indicators. Most accepted: biological indicators
What are the various ways to assess if your sterilizer is working properly and what is the most accepted method?
blood
What body fluid contains the greatest proportion of HBV infectious particle titers and is the most critical vehicle of transmission in the health-care setting?
gloves surgical masks protective eyewear face shields gowns/jackets
What does PPE stand for and entail?
-handpieces -ultrasonic tips -air polishing tips -burs -rinn cassettes
What instruments CANNOT go into miele
It is a rapidly progressive, invariably fatal, degenerative neurological disorder. Caused by a prion. Prions exhibit unusual resistance to conventional decontamination procedures. Transmission during dental procedures is low to nil, but considering this resistance and the invariably fatal outcome of CJD, until additional info exists regarding transmission, standard precautions are indicated when treating known CJD patients. (Us e single-use disposable items when possible, consider items which are difficult to clean as single-use, keep instruments moist until cleaned, clean thoroughly and autoclave, do not use flash sterilization)
What is Creutzfeldt-Jacob disease and why is of concern to dentistry?
infectious waste that carries a substantial risk of causing infection during handling and disposal. No, we have not (examples: waste soaked with blood or saliva, extracted teeth, surgically removed tissues, contaminated sharps)
What is regulated waste and have you experienced it in Clinic I?
percutaneous injuries (needlesticks and other blood contacts)
What is the cause of occupational exposures to blood in dentistry that poses the greatest risk of disease transmission?
housekeeping surfaces have limited risk of disease transmission. Clinical contact surfaces can be directly contaminated from patient materials
What is the difference between a clinical contact surface and a housekeeping surface?
ICD - common nonallergic and develops as dry, itchy, irritated areas the skin around the area of contact ACD - can result from exposure to certain substances. Often manifests as a rash beginning hours after contact
What is the difference between irritant contact dermatitis and allergic contact dermatitis
reusable instruments, supplies, and equipment should be received, sorted, cleaned, and decontaminated in one section of the processing area. (Cleaning precedes disinfection and sterilization)
What is the receiving, cleaning, & decontaminated procedure for managing contaminated dental instruments?
hand hygiene
What is the single most critical measure for reducing the risk of transmitting disease?
drain, disinfect and dry ultrasonic
What needs to be done every thursday
instruments recleaned, repackaged, and resterilized
What should you do if you are working the sterilization center and you notice that a "sterilized" instrument packet is torn?
dentazyme
What solution goes into ultrasonic
non petroleum-based formulations
What types of hand lotions are acceptable to use in the dental care setting?
when it is visibly soiled, if penetrated by blood or other body fluids, before leaving the work area
When do you need to change your overgown?
before donning gloves immediately after glove removal (water temp?)
When do you need to wash your hands in terms of glove use? What water temp?
(???) in procedures less than 45 minutes (???)
When is it appropriate to "double-glove"?
when they are to be used immediately and can be transported aseptically. Conditions: 1) thorough cleaning and drying of instruments precedes the unwrapped sterilization cycle 2) mechanical monitors are checked and chemical indicators used for each cycle 3) care is taken to avoid thermal injury to DHCP or patients 4) items are transported aseptically to the point of use to maintain sterility
When is it appropriate to use unwrapped sterilization methods and what conditions must occur?
when it is freshly applied (chipped nail polish can harbor added bacteria)
When is nail polish okay?
Why do we use powder-free gloves in the clinic?
When powdered latex gloves are worn, more latex protein reaches the skin. In addition, when powdered latex gloves are donned or removed, latex protein/powder particles become aerosolized and can be inhaled, contacting mucous membranes. As a result, allergic patients and DHCP can experience cutaneous, respiratory, and conjunctival symptoms related to latex protein exposure
Why is it frugal to restrict the wearing of rings?
Whether wearing rings increases the likelihood of transmitting a pathogen is unknown; further studies are needed to establish whether rings result in higher transmission of pathogens in health-care settings. However, rings and decorative nail jewelry can make donning gloves more difficult and cause gloves to tear more readily
To reduce the number of microorganisms the patient might release inthe form of aerosols or spatter. Also can decrease the number of microorganisms introduced in the patient's bloodstream during invasive dental procedures.
Why and when do we have our patients use an antimicrobial mouthrinse?
because of risks associated with exposure to chemical disinfectants and contaminated surfaces
Why are you to wear a mask and nitrile gloves when disinfecting your operatory?
to facilitate the retrieval of processed items in the event of a sterilization failure
Why do we date and initial the sterilization packages?
prevent contamination of clinical contact surfaces, easy to transition between patients
Why do we use barriers?
Natural rubber latex proteins responsible for latex allergy are attached to glove powder. When powdered gloves are worn, more latex protein reaches the skin. Also, latex protein become aerosolized and can be inhaled.
Why do we use powder-free gloves in the clinic?
they cause gloves to tear more readily
Why is it frugal to restrict the wearing of rings?
possible positive BI (when the unit is still operating properly)
Why is it important not to over-pack the sterilizer (specifically what happens)?
dental unit waterlines can become colonized with microorganisms which colonize and replicate on the interior of the tubing and form a biofilm, which serves as a reservoir that can amplify the number of free-floating microorganisms in water used for dental treatment
Why is there a concern over biofilm in the dental unit water lines?
skin bacteria can rapidly multiply under surgical gloves
Why should hand antiseptic products have a persistent effect?
Hot packs act as wicks, absorbing moisture, and hence, bacteria from hands
Why should you allow the instrument packs to dry in the sterilizer before removing them?
When a mask becomes wet from exhaled moist air, the resistance to airflow through the mask increases, causing more airflow to pass around the edges of the mask
Why should you change your mask once it becomes wet?
the majority of flora on the hands are found under and around the fingernails (Nails should be short enough to allow DHCP to thoroughly clean underneath them and prevent glove tears.)
Why should you keep your fingernails short?
Backflow. It can be a potential source of cross-contamination.
Why should you not let your patient close his/her mouth around the saliva ejector "like a straw"?
it can lead to the formation of glove micropunctures and subsequent hand contamination
Why should you not wash your gloves?
Hand carriage of gram negative organisms has been determined to be greater among wearers of artificial nails than among non-wearers (Also, artificial nails have been implicated in multiple outbreaks involving fungal and bacterial infections (in hospital intensive-care units and operating rooms)
Why should you not wear artificial nails, even if kept short?
to physically flush out patient material that might have entered the turbine, air, or waterlines
Why should you run a dental handpiece that uses water 20-30 seconds after the dental procedure has been completed?
Can an individual that is a carrier of Hepatitis B work as a dental receptionist? Why or why not?
Yes, as that position does not perform exposure-prone procedures.
Is our liquid soap dispensing system the ideal? Why or why not?
Yes, because pathogenic organisms have been found on or around bar soap during and after use
How long is your dentist-employer required to keep your confidential medically related information?
at least the duration of employment plus 30 years
What body fluid contains the greatest proportion of HBV infectious particle titers and is the most critical vehicle of transmission in the health-care setting?
bloodand blood-contaminated saliva
NO
can gloves be worn outside of the op
Given the scenario that you received the primary vaccine series for HBV, what should you do if you did not develop an adequate antibody response?
complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive. If no antibody response occurs after the second series, testing for HBsAg should be performed
How are you to manage a dental impression before taking it to the materials lab to pour up your model?
disinfected with an EPA-registered hospital disin- fectant with a tuberculocidal claim, and thoroughly rinsed
When is it appropriate to "double-glove"?
during longer procedures (i.e., >45 minutes) and during oral surgery procedures
24 hours
how long must biological indicators stay in incubator
once a month
how often do utility gloves go through sterilization
every 20 minutes
how often should mask be changed if it is moist
How long can HBV survive in dried blood at room temperature on an environmental surface?
less than or equal to 1 week
-seek first aid ASAP -report accident to emergency contact (faculty) -within 1 hour follow accident procedure -if DR care is needed, seek care and take ACC insurance and HIPAA forms
list steps for accident procedure at ACC
(with PPE on) -wipe off handpieces and ultrasonic inserts, return to cases -don utility gloves, put cassettes in bin and take to sterilization center -remove barriers -wash utility gloves, wipe, put away -wash hands, don nitrile gloves -connect and clean suction lines -clean housecleaning and clinic surfaces -disinfect bin and put away -store foot controls -wipe sink -remove gloves wash hands (15/10) -empty water bottle -flush water lines (to purge H20) -dry sink -turn off master switch -log off eaglesoft, store mouse and keyboard
list the steps for infection control of op at end of day
What types of hand lotions are acceptable to use in the dental care setting?
lotions that do not contain petroleum or other oil emollients
-clinician stool -patient chair -safety glasses -overhead light
name the items that must ONLY be cleaned with dawn solution
-reception -records room -faculty offices
name the places overgowns are NOT allowed
-deliver instruments to sterilization -WITH gloves, flush lines for 20 seconds -remove barriers -clean and disinfect all soiled surfaces -apply new barriers
names the steps for infection control BETWEEN patients
Why is it important not to over-pack the sterilizer (specifically what happens)?
overloading the sterilizer chamber can result in cool air pockets and items not being sterilized.
In the text the acronym DHCP is used - what does it reference?
refers to all paid and unpaid personnel in the dental health-care setting who might be occupationally exposed to infectious materials ie dentist, dental hygienest, dental assistant, front desk
Dr. Pearce just provided a local anesthesia injection and turned over the used syringe to you, how are you going to recap the contaminated needle?
the practitioner should recap the needle between injections by using a one-handed technique or use a device with a needle-resheathing mechanism. Passing a syringe with an unsheathed needle should be avoided because of the potential for injury.
Why should you keep your fingernails short?
to thoroughly clean underneath them and prevent glove tears
-clinic -sterilization center -materials lab -laundry area
what are the designated areas that overgowns can be worn
-purple -yellow
what color will bio indicator be if negative? positive?
handpieces
what items go in the assistina
-bagged instruments
what items go in the autoclave
-heat sensitive reusable items
what items go in the cold sterile
cassettes of instruments
what items go in the miele
-cassettes of instruments -small items (burs)
what items go in the ultrasonic
-run bio indicator in autoclave and statim, record in log book -crush and place in incubatorwith control
what needs to be done on FIRST clinic of the week
-record results for bio indicator -dispose of indicators in biohazard trash
what needs to be done on LAST clinic of the week
de-gas (run for 10 minutes)
what should be done after solution is mixed in ultrasonic
gluteraldehyde
what solution is used in cold sterile
Why should you change your mask once it becomes wet?
when a mask becomes wet from exhaled moist air, the resistance to airflow through the mask increases, causing more airflow to pass around edges of the mask.
1st and 15th of the month (if dawn solution low, change)
when are filters changed on the unit
in cubbies in hallway
where are personal items stored during clinic
