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

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. The majority of tabletop sterilizers used in oral healthcare settings are gravity displacement sterilizers. D. Gravity displacement steam sterilizers should be tested daily for adequate air removal.

Gravity displacement steam sterilizers should be tested daily for adequate air removal- not true, high speed prevacuum sterilizers need to be tested daily

All of the following statements related to critical or semi-critical, or non-critical patient-care items are correct except which one? 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 high-level disinfection using an FDA-registered chemical sterilant/high-level disinfectant. D. Unless visibly soiled, for non-critical items disposable barrier protection is the preferred infection control method during their use.

Heat- sensitive critical items must minimally undergo high-level disinfection using an FDA-registered chemical sterilant/high-level disinfectant

All of the following statements relative to the sterilization monitoring record (SMR) are correct except which one? 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).

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 are correct with respect to sterilizing wrapped instruments loading instruments except which one? 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 onside the chamber.

Once the sterilization cycle is complete, remove the packs to cool and dry onside the chamber- No, they dry inside the chamber

All of the following statements are correct with respect to cleaning reusable instruments and other devices except which one? 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.

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

Which of the following statements is correct with respect to biological monitoring of the sterilization process? 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. All of the above are correct.

All are correct

Which of the following statements is correct with respect to the use of chemical sterilants and disinfectants? 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.

All are correct

Which of the following statements is correct with respect to the various quality assurance indicators of the sterilization process? 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 are applied either to the outside or placed on the inside of each instrument unit to be sterilized. C. Biological indicators (BIs), or spore tests, assess directly the killing of known highly resistant, nonpathogenic bacterial spores. D. All of the above are correct.

All are correct

Which of the following statements related to critical or semi-critical, or non-critical patient-care items is correct? A. Heat tolerant critical and semi-critical items must be sterilized by steam, unsaturated chemical vapor, or dry heat. B. 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. C. Non-critical items, when visibly soiled, must be disinfected with an EPA-registered hospital level intermediate-level disinfectant. D. All of the above are correct.

All are correct

Which of the following statements best describes Spaulding's classification of patient-care items? 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. All of the above are correct.

All the above

Which of the following statements is correct with respect to procedures to follow in the event of a positive spore test? 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 performing correctly and the repeat BI test is positive, the sterilizer should remain out of service until it has been inspected, repaired, and re-challenged with BI tests in three consecutive empty-chamber sterilization cycles. D. All of the above are correct.

All the above

Which of the following statements is correct with respect to processing contaminated reusable patient-care items? 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 CPA, each station should be physically separated to control traffic flow and to contain contaminants during the process. C. 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. D. All of the above are correct.

All the above

Which of the following statements is correct with respect to dry heat sterilization? 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. All of the above are correct.

All the above are correct

All of the following statements are correct with respect to detergents and enzymatic cleaners except which one? 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 neutral 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.

Detergents with an acidic pH generally provide the best material compatibility profile and good soil removal- neutral works best

All of the following statements are correct with respect to preparing and packaging instruments except which one? 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.

Hinged instruments placed in various packs must be in a closed, locked position- wrong, they must be open/unlocked

All of the following statements are correct with respect to sterilization and levels of disinfection except which one? 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 kill spores. D. Low-level disinfection kills some nonlipid or small viruses (e.g., polio), some fungi, all vegetative bacteria, and all lipid or medium-size viruses (e.g., HBV, HIV).

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 kill spores

All of the following statements are correct with respect to storing sterilized items except which one? 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.

Storage practices for wrapped sterilized instruments are time-related, i.e., recognize that wrapped instruments maintain their sterility for a specified time. They are event related- meaning, unless they are used, they are clean indefinitely

All of the following statements with respect to unsaturated chemical-vapor sterilizers are correct except which one? 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.

The advantage of using unsaturated chemical-vapor sterilization is that the instruments do not have to be dry before sterilization- WRONG, they need to be dry before sterilization

All of the following statements are correct with respect to sterilizing and high-level disinfecting with germicides except which one? 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).

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 sterilizing unwrapped instruments and their use except which one? A. Unwrapped the 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.

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