OSHA and CDC
Microbial dose load
-the dose load of microorganisms present in a specific area
whats the difference between a universal and a standard precaution
.Treats all patients and materials as potentially infectious. a standard precaution would be more specific.
how many layers of instruments are permitted in the autoclave
1
*what are the three types of regulated medical waste
1. Blood and blood saturated materials 2. Pathological waste (e.g. tissues and extracted teeth) 3. Sharps
what are the steps in the processing cycle of instruments (6)
1. Instruments must be transported in a holding/transporting container from the operatory to the sterilization area 2. Optional holding solution if not cleaned immediately 3. Ultrasonic cleaning 4. Instrument packaging/Internal chemical monitoring/ Labeling 5. Sterilization process/Mechanical monitoring/ Biological monitoring 6. Instrument storage
what does the CDC do
1. collects scientific data and makes recommendation 2. tracks disease trends 3. protects workers AND patients 4. controls spread of infection
when were guidelines enforced
1991. mandatory blood born pathogens standards issued.
how often does our lab check for sterilization of spores
1x/week as per CDC, ADA and OSAP recommendation. varies state to state
how long do discharge water after each patient from any device connected to the water system that enters the mouth
20-30 seconds
What is the max amount of CFU in a dental water unit line recommended by ADA
200 CFUs
when should the solution be changed
2x/day or when cloudy
how are HBV shots given- sequence and timing of injections and titer reading
3 injections: day one, day 30 and 6 months. then 1-2 months later a titer is taken
how long are training records kept
3 years
what is an infectious agent
?The agents that cause disease fall into five groups: viruses, bacteria, fungi, protozoa, and helminths (worms).?
what is a pathogen
?a bacterium, virus, or other microorganism that can cause disease.?
what is infection control
A system of measures practiced by health care personnel
what does APIC stand for
Association for professionals in infection control and epidemioloy
types of sterilization methods
Autoclave ▸ Dry heat sterilizer ▸ Rapid heat transfer sterilizer ▸ Unsaturated chemical vapor- (chemiclave) ▸ Ethylene Oxide- ▸ Chemical sterilants-
which is preferred- barriers or disinfectants? why?
Barriers are preferred over disinfectants because they reduce exposure to chemicals and save time in operatory processing
what are airborne pathogens
Chickenpox, Influenza, Measles, Smallpox, Tuberculosis.
*Noncritical processing
Contacts intact skin (radiograph head/cone, blood pressure cuff)
a disinfectant must be registered with what organization
EPA
Hospital-level germicide
EPA registered germicide for disinfecting environmental surfaces in healthcare setting (noncritical surfaces)
chemical vapor sterilizer
Ethylene oxide
what is the goal of infection control
Goals to decrease transmission of infectious agents
which is more virulent- HBV or HIV
HBV. It lives 7 days outside the body. HIV lives for 30 minutes.
what are lipid or medium sized bacteria
HIV Herpes HepB and C
If a disinfectant is a tuberculocidal, it also kills what
HIV and HBV
what are blood born pathogens
HIV, HBV and HCV,
what are chemical indicators
Heat sensitive chemicals that display a color or a physical change once the inside of the sterilizer has reached a certain temperature
which is the most common occupational disease acquired in the dental setting
Hep B
what are the recommended CDC immunizations
Hep B Influenza MMR (measles, mumps, rubella) Tdap (tetanus, diptheria, pertussis) Varicella/chicken pox sometimes: meningitis and typhoid
what do you do if you got chemicals in your eyes
Irrigate with clean water, saline or sterile solution. Notify the Exposure Control Manager
Intermediate level disinfectant is used for what type of surface
NONCRITICAL
what is does the sharps and the needlestick prevention act mandate
New devices used for needlestick safety should be screened, evaluated by those who will use them, and forms should be kept in the written Exposure Control Plan as documentation of the OSHA mandate
Is latent TB infectious?
Night
what are other relevant organizations that have developed recommendations for safer workplaces
OSAP, ADA, ADHA, ADAA, APIC
what does OSHA stand for
Occupational Safety and health and administration
when cleaning the operatory, what should be worn
PPEs
where can you find detailed procedures regarding an exposure incident?
Postexposure Management Plan
besides hygiene, what are the otherduties/roles of the hygienist
Product selection ▸ Purchasing ▸ Inventory control ▸ Research
what are some ways to make patients aware of measures being taken to control exposure
Proper clothing in reception area and other general areas ▸ Open packaged sterilized instruments in front of the patient ▸ Offer patient eyewear ▸ Offer a pretreatment mouthrinse ▸ Wash your hands and don gloves in front of the patient
what is the correct order of donning PPEs
Protective clothing/Lab coat ▸ Eyewear ▸ Mask ▸ Gloves
what are high level disinfectants used on
SEMICRITICAL items that cannot withstand heat or ethylene oxide sterilization
*each chemical in the office must have a what
Safety data sheet (SDS)
how should instruments be stored
Should remain packaged for storage ▸ Storage area should be clean, dry and closeable
what are key factors in choosing disinfection chemical
Staff/patient compatibility, nontoxic ▸ Storage requirements ▸ Ease of use ▸ User satisfaction ▸ Shelf life ▸ Disposal ▸ Cost
Clinical contact surfaces
Surfaces that are touched by contaminated hands, instruments, devices, or other items, during dental or medical care
after treatment, where do contaminated instruments go
They should be transferred immediately to the instrument recirculation area
who established OSHA and when
US government in 1970s
what methods are used to insure patient safety regarding water borne illness
Use anti-retraction valves ▸ Use water treatment regimen according to manufacturer recommendations ▸ Use In-line filters
what is holding solution for
Used if instruments cannot be cleaned immediately after patient treatment
what does exposure control do
Uses the concepts and strategies of infection control to prevent exposure to infectious agents and limit the spread of infectious agents when exposure occurs
how is HBV spread?
VIRUS, bacteria, toxins, certain drugs or physical injury
How long does item need to be in autoclave to be sterile
Warm up plus 20 minutes and cool down
*what do you wear on your hands to transport bloodied instruments
Wear appropriate PPE's and utility gloves
when does waste need to be regulated
When there is a substantial risk of causing infection during handling E.g.: gauze saturated with blood
Is latent TB detectable
Yes it will show positive
what is toxic waste
a subset of hazardous waste and is capable of having a poisonous effect
what type of trainng takes place when there are changes in policies, procedures, or products, if new info is available, or if someone doesnt follow standards operatiiong procedures
additional training
*how often are handpieces sterilized
after every use
how is TB spread
airborne bacteria
what is bioburden
amount of biological or organic material on a surface. e.g. saliva
what are exposure controls
an all incompasing term. incorporates all the aspects of Infection Control with the related principles of occupational safety and health. goal is prevention.
what are OSHA universal precautions
an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens,
Noncritical surfaces
an item or surface in the treatment area that does not touch or penetrate human tissue, but may become contaminated by aerosolization, spatter, or contact with contaminated items.
which type of training is required for specific OSHA standards such as the Bloodborne Pathogens Standard and is good office policy
annual
what type of hazards does dental waste pose?
any combination of the infectious, chemical, and/or physical. most is general waste though.
what is hazardous waste
any waste that poses a risk or peril to humans or the environment, but does not have to be infectious
which handpieces should be sterilized
anything that can be removed (i.e. polisher)
labels on containers of hazardous chemicals must have what
appropriate hazard warnings id of the chemical manufacturers name and address
what is fungi
aspergilllus candida
which sterilization method uses steam heat under pressure
autoclave
Is TB a virus or bacteria
bacteria
when useing the ultrasonic, when do you rinse the instruments
before and after the cycle
what is the only full proof method to verify sterilization
biologic monitoring
what do automated methods of instrument cleaning do
break up and loosen debris
what does CDC stand for
center for disease and control
*what do employees need to know about the chemicals
chemical handling, safety and emergency response in the event of an exposure or spill in, specific to their job duties
high level immersion disinfectants, used for items that cannot withstand exposure to heat or ethylene oxide
chemical sterilants
if a disinfectant does not contain a surfactant, what is necessary before disinfecting
cleaning
if using a computer to document client info, what type of environmental control is being observed when you wipe it down
clinical contact
two subcategories of environmental controls
clinical contact surfaces housekeeping surfaces
Biofilm
colonization of slime protected microbial communities that may harbor bacteria, fungi, protozoa and microscopic nematode worms
*Semicritical processing
contacts mucous membranes or non-intact skin (mouth mirror, impression trays, dental handpieces)
how is staph spread
contaminated hands of health care professionals, by contact. May live several weeks outside host
what type of processing for periodontal instruments
critical
what are the 3 categories of procedures for processing instruments
critical semicritical noncritical
what the different ways we can monitor sterilization
cycle indicators, chemical indicators biologic monitors
how should packages be labeled
date of sterilization, cycle number and type of instruments (unless packaging is clear), name or initials of packager, and sterilizer used
*what is the cradle to grave concept
dental practice is responsible for the hazardous waste it generates until it is destroyed or rendered nonhazardous ▸
what does the sterilization process accomplish
destroys all microbial forms including bacterial endospores
what water is used for the autoclave
distilled
an agents ability to infect depends on what two factors
dosage (how much) virulence (how strong)
how is TB spread?
droplet nucei in the air
if there is exposure to a patients body fluid what happens next
employee with see their health care provider, take baseline tests, review patient's information and possibly given post exposure prophylaxis. counseling is provided if there is a positive test result. Possible workers comp
what does OSHA mandate
employers must "furnish to each of his employees, employment and a place of employment, which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."
type of control? operating the heat sterilizer
engineering control
Housekeeping surfaces
environmental surfaces that are not involved in the direct delivery of dental care (floors, walls)
with which gloves are clean barrier placed
examination gloves
which type of OSHA control has programs that are part of the offices standard operating procedures and practices and should be routinely evaluated
exposure control
Government stipulations are that all employees be aware of its contents and prescribed procedures which can be found in the _________?
exposure control manual.
true or false: the garbage man is responsible for proper disposal of hazardous dental waste
false. the dentist is and must keep a record
All confidential employee medical records must be kept for how long
for duration of employement and 30 years after
what can be done to keep sharp instruments from piercing the package before sterilization
gauze can be placed around sharp instruments
resistance of a host depends on what two factors
general health immunization status
what are the most common mechanism of transporting contamination
hands
what type of waste are lead foil, amalgam, spent fixer
hazardous waste
what type of waste is an extracted tooth filled with amalgam
hazardous waste
is immersion disinfection intermediate or high level sterilization
high level
the following are what type of disinfectant: Glutaraldehydes, hydrogen peroxide, paracetic acid
high level
what type of disinfectant would a mouth impression tray be submerged in
high level
*which level of disinfectant can kill: endospores, TB, hydrophilic and lipophilic viruses, fungi and vegetative bacteria
high level disinfectant
type of control? cleaning the counters daily
housekeeping controls
what type of container should be used when transporting instruments after treatment (dirty instruments)
in a container that is puncture resistant, leakproof with solid sides and bottom and has a biohazard label, a lid would be valuable
*when do we open clean, packaged instruments
in front of the patient
where are workplace emergency procedures kept
in the comprehensive emergency procedures plan
what are the three areas where employees are at risk of potential exposure
infectious chemical physical
what 3 items do the SDS sheets describe
ingredients, hazards and emergency procedures for each chemical
what are the three types of OSHA trainign in the work place
initial additional annual
what type of training is given when there is a change in responsibilities of staff, office procedures wheere there is a potential for an occupational hazard and in response to changes in governemtn regulations or recommendations
initial training
the following are what type of disinfectant: Iodophors, alcohol, synthetic phenolics, dual or synergized quaternaries, sodium bromide and chlorine
intermediate level
which level of disinfectant kills: TB, hydrophilic and lipophilic viruses, fungi and vegetative bacteria
intermediate level disinfectants
if you have a positive TB test but you are not infectious, what do you have
latent TB
how much time should a surface disinfectant require to kill TB
less than 10 min
Which level of disinfectant kills: Destroys certain viruses and fungi but not TB
low level
what type of disinfectant is needed to kill vegetative bacteria and lipid viruses: e.g. staph, salmonella, HIV, herpes,
low level hospital disinfectant
*what are the three levels of disinfectants
low level intermediate high level
what disinfectant is used for general housekeeping
low level disinfectant
which level of disinfectant is used on a clinical contact surface not contaminated with blood
low level disinfectant
simple quaternary ammonium compounds, detergents
low level disinfectants
how to wash hands
lukewarm water interlace fingers 15 seconds rinse and dry thouroughly turn off faucet with towel
Hospital level disinfectants
most critical to infection control and use on dental instruments, floors, walls, bed linens, toilet seats and other surface
TB is what bacteria
mycobacteria mycobacterium tuberculosis
are medical hx questionnaires reliable
no
does the ultrasonic sterilize
no
if a package of instruments is opened, is it still sterile
no
is there a pre or post exposure prophylaxis for HCV
no
is there a vaccine for Hep C
no
are sterilization chemical indicators full proof
no because the autoclave could have reached the target temp but not for the full 20 min. also still need to check for endospores
is there an increased risk for HCW to contract HCV? why?
no. Spread primarily through BLOOD contact, sexual transmission or during pregnancy
can PPE's last forever
no. they have an expiration date
what type of processing for a BP cuff
non-critical
the arm of the operatory would be considered what type of surface
noncritical. still requires wiping due to aerosolization
where is a face mask placed when walking out of the operatory
on a paper towel
can we sterilize unpackaged instruments
only in specific situations
what does OSAP stand for
organization for safety, asepsis, and prevention
what type of waste is an extracted tooth
pathological waste
*Critical processing
penetrates soft tissue, contacts bone, enters into or contacts the bloodstream or other normally sterile tissue (surgical instruments, periodontal scalers)
what are nonlipid or small viruses
polio coxsackle rhinoviris
what are over gloves used for
prevention of cross contamination e.g. using the keyboard
when are packages labeled
prior to sterilization
what does OSHA do
protects the health and safety of all workers
what is the purpose of packaging instruments
provides a barrier for instruments after sterilization
what is the CDC
public health agency in the US
can you tell if someome has HBV
rarely. 80% of the time no symptoms show. and 50% of people dont know they have it
infectious sharps and infectious nonsharps
regulated medical waste
*what if there is a tear in the packaging after sterilization
repack and re-sterilize
*if there is any death of hospitalization of 3 or more workers, that must an office do
report it to OSHA
which items should undergo immersion disinfection
reusable semicritical items that cannot withstand heat or ethylene oxide
what are post exposure management policies for bloodborne exposures
see designated HCP patient tested (if they agree) post exposure prophylaxis counseling this is at no cost to the employee
what type of processing for a dental film holder
semi-critical
if handling a physical patient's record/file during treatment, what are the risks to exposure to HIV
spatter, aerosols, contact with treatment gloves and equipment. pt records should never be in close proximity to clinical area
how do you clean the operatory
spray wipe spray
how are Chickenpox/Varicella Zoster, Flu/Influenza spread?
spread through droplets. N95 mask recommended
What is vegetative bacteria
staph salmonella
what type of water is used if bone is exposed
sterile
the higher the _____, the better at breaking up dirt and debris
surfactant
compare surgical hand antisepsis and regular hand washing
surgical hand washing involves washing hands AND arms. antiseptic hand rub involves alcohol based hand rub. regular hand washing involves the use of soap
who is responsible for laundering lab coats
the dentist
who pays for HBV immunizations
the dentist
Low level disinfectants
the major source of products used in households, swimming pools and water purifiers ▸
what is antisepsis
the practice of using antiseptics to eliminate the microorganisms that cause disease.
Disinfection
the process of decontamination, which kills most microorganisms, with the exception of spore-forming organisms left on a surface after cleaning
what is biologic monitoring
the use of paper strips or glass vials containing non-pathogenic highly resistant bacterial endospores
what happens if the sterilizer is overloaded
there will be cold spots
how are immersion disinfectants verfied for sterilization
they arent
what is the purpose of having an exposure control manager
they manage the practice's training program and ensure documentation is properly maintained
what is the purpose of cleaning an operatory before disinfecting it
to reduce bioburden
Cleaning
to remove visible debris and dirt by use of a detergent and mechanical means prior to disinfection and/or barrier protection
*true or false: CDC requires maintenance of records of work related medical management
true
True or false: New label only applies when product is removed from the original container, then must contain same information as original label
true
true or false, the FDA considers barriers as medical devices
true
you wear a face mask with a face shield. true or false
true
true or false: patient exam gloves are considered a medical device
true. regulated by the FDA.
what are the differences between OSHA and CDC
two distinct organizations OSHA oversees safety of work practices to protect workers CDC oversees public health
how to test for effectiveness of automated cleaners (e.g. the ultrasonic)
use a strip of aluminum foil 2X3 inches for 20 seconds and check in light for small holes, which should be present
what type of control? wearing heavy duty utility gloves, eye protection, etc
use of PPEs
what are the precautions of handling sharps
use single handed method of recaping use disengaging device to uncap dispose of sharps immediatelly wipe debris on taped down cotton rolls fulcrum a tooth that you arent working on only hold one instrument in a hand at a time
what are CDC standard precautions
used for all patient care. They're based on a risk assessment and make use of common sense practices and personal protective equipment use that protect healthcare providers from infection and prevent the spread of infection from patient to patient. e.g. donning PPEs and hand hygiene
what are utility gloves used for
used for handling contaminated sharps sanitized after use not a medical device
how long does sterilization take
warm up time 20 min then cool down
what do you do if you got someones body fluids on your broken skin/rash
wash with soap and water Notify the Exposure Control Manager
what do you do for a puncture wound
wash with soap and water and control bleeding. Notify the Exposure Control Manager
when should you use a face shield
when using an Ultrasonic scaling, air polishing and high-speed handpieces
how are protective glasses cleaned
with soap and water
type of control? proper training on how to use the sterilizer
work practice controls
who does OSHA protect
workers/employees
what are the 5 main parts to the chemical hazard communications program
written program chemical inventory SDS container labeling employee training
what are these: Standard Operating Procedures ▸ Employee Health Records ▸ Employee Training Records ▸ Emergency Procedures Plans ▸ Chemical Safety Records ▸ Dental Waste ▸ Miscellaneous
written reports
is saliva a potentially infectious material?
yes
is there a higher number of bacteria in untreated dental unit water lines
yes
is an immersion disinfectant considered a medical device by the FDA
yes (most are hazardous chemicals)
Are PPE's considered medical devices?
yes they are regulated by the FDA
can OSHA request copies of training records
yes to verify compliance
*is amalgam hazardous waste
yes contains mercury
is there a difference virulent factors when stuck with a needle used on a patient in early stages of HIV verses late stage
yes. but otherwise, usually the risk is .3%
what information is included in the training documentation
▸ Date and length of training ▸ Conductor of training and qualifications ▸ Names and job titles of attendees ▸ Content of training
what are the four steps of managing regulated waste
▸ Handling, segregating and storing ▸ Labeling ▸ Disposing ▸ Record keeping
when handling sharps, what are some ways to prevent an injury
▸ Never recap needles using two hands ▸ Never disengage a capped needle from a syringe by hand ▸ Dispose all non reusable sharps in a sharps container ▸ Never wipe debris from an instrument with gauze ▸ Never fulcrum on the same tooth you are working on ▸ Always hold instruments by the handle and one at a time
What are at least 3 responsibilities of the ECM
▸ Scheduling and monitoring training for all personnel ▸ Maintaining training materials and records ▸ Customizing the course materials for the office setting ▸ Answering questions and providing ongoing training ▸ Determining where, how and which employees are at risk ▸ Exposure risk is made without consideration to PPE's used
what are the housekeeping records (5)
▸ Sterilization monitoring log ▸ Biologic monitoring log ▸ Equipment maintenance and repair ▸ Dental unit waterline maintenance log ▸ Housekeeping schedule
what are the OSHA required protection methods
▸ Universal/Standard Precautions ▸ Work practice Controls ▸ Engineering Controls ▸ Personal Protective Equipment ▸ Environmental Infection Control
what are some ways to reduce aerosolization and splatter
▸ Use high-volume evacuation (HVE) ▸ Use a dental dam ▸ Use correct PPE's ▸ Use a preprocedural mouthrinse for each patient to reduce microbial dose load
what are the 5 primary controls/protection methods
▸Universal/Standard Precautions ▸ Work practice Controls ▸ Engineering Controls ▸ Personal Protective Equipment ▸ Environmental Infection Control
