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patient safety > decontamination > Flashcards

decontamination Flashcards

1
Q

what is a ‘critical device’?

A

a device that penetrates soft tissues, makes contact with bone and enters or contacts the bloodstream or normally sterile tissue

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2
Q

what is a ‘semi-critical’ device?

A

a device that comes into contact with non-intact skin or mucous membrane, but does not penetrate soft tissue or make contact with the bloodstream, bone or normally sterile tissue

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3
Q

what is a ‘non-critical device’?

A

a device that only comes into contact with the skin and intact mucous membrane

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4
Q

give examples of a critical device

A

surgical and biospy instruments
forceps

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5
Q

give examples of semi-critical devices

A

dental mirrors
anaesthetic syringes

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6
Q

give an example of a non-critical device

A

chair light handle

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7
Q

how should a critical device be reprocessed?

A

cleaned and then sterilised

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8
Q

how should a semi-critical device be reprocessed?

A

cleaned and subject to high-level disinfection
steam sterilisation preferred

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9
Q

how should a non-critical device be reprocessed?

A

cleaning followed by low level disinfection

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10
Q

describe the life cycle for processing instruments

A

cleaning
disinfection
inspection
packaing
sterilisation
transport
storage
use
transport
back to cleaning

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11
Q

give 5 reasons as to why instruments must be cleaned as the first stage of the cycle

A
  1. functionality of instrumentation
  2. to minimise the spread of contamination
  3. to prevent failed procedures (biopsy)
  4. to achieve steam contact
  5. it is a legal requirement
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12
Q

what is the recommended cleaning method for dental instruments?

A

automated process in a washer-disinfector
back up method- ultrasonic bath
manual cleaning should only be carried out if it is the only option

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13
Q

what are the 2 types of steam steriliser?

A

vacuum (type B)
non-vacuum (type N)

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14
Q

how does the scottish health technical memorandum define an ‘operator’?

A

a person, designated by management, with the authority to operate a WD. their duties may include the noting of WD instrument readings, replenishment of consumable items, such as detergent and simple housekeeping

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15
Q

what PPE is required to carry out manual cleaning of instruments?

A

an apron
face shield
rubber gloves

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16
Q

describe the requirements of the sinks used for manual cleaning

A

dedicated sink for manual washing only
separate sink used for rinsing the instruments

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17
Q

describe the requirements for the water used for manual cleaning

A

standard portable water/tap water can be used
water must be between 30-35C
>35C causes proteins to coagulate, making them more difficult to remove

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18
Q

describe the requirements of the chemical detergents used in manual cleaning

A

should be formulated specifically for manual cleaning, generally an enzymatic or pH neutral detergent
manufacturers instructions should always be followed

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19
Q

why is a metallic brush never used for manual cleaning?

A

could damage the instrumentation

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20
Q

why should instruments be scrubbed below the water during manual cleaning?

A
  1. instruments must be in contact with water and detergent solution
  2. while carrying out the process it is essential to minimuse splashing to avoid contamination of surroundings
  3. scrubbing above surface has potential to create aerosols
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21
Q

give 3 examples of when it would be appropriate to carry out manual cleaning

A
  1. it is specifically recommended by manufacturer’s instructions
  2. no other alternative
  3. the automated process of the ultrasonic or WD has failed to remove the contamination
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22
Q

how does the ultrasonic bath operate?

A

uses soundwaves at very high frequencies to produce bubbles that implode and have a scouring effect against the hard surface of the instruments

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23
Q

explain the process of cavitation

A

sound waves pass through the water and cause micro bubbles to form
the fluctuation in pressures the sound waves induce cause bubbles to rapidly expand and then collapse

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24
Q

what is the operating temperature of the ultrasonic bath?

A

20-30C

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25
Q

what is the purpose of a degas cycle during ultrasonic cleaning?

A

there are gas/air bubbles inside water normally
during ultrasonic process, any bubbles created will collapse into these air bubbles
this effects efficacy of equipment and prevents proper cleaning of instrumentation

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26
Q

what are the 5 stages of the automated washer- disinfector?

A
  1. flush/prewash
  2. main wash
  3. rinse
  4. thermal disinfection
  5. drying
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27
Q

what temperature must each stage of the washer-disinfector be carried out at?

A
  • flush/prewash= <35C
  • MAIN WASH= depends on chemical used
  • rinse= <65 degrees
  • thermal disinfection= 90-95C for a minimum of 1 minute
    *
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28
Q

name 6 daily checks for the washer-disinfector

A
  1. check that the sprays arms spin freely without obstruction
  2. check the spray jets are not blokced
  3. maure sure there is no debris on the strainer/filter and that there are no parts of instruments or any other potential blockages
  4. check the condition of the door seal and wipe clean if necessary
  5. verify there is a suitable amount of chemical in the reservoir
  6. record the disinfection temp of the first cycle every day
29
Q

what are the 5 loading requirements of the washer-disinfector?

A
  1. the avialble load carrier/basket furniture must be used
  2. clip trays must be used and positioned correctly
  3. no overlapping or shadowing of equipmetn
  4. hinged instruments must be opened at the hinge
  5. all assemblies should be disassembled beforehand
30
Q

what is used to inspect instruments after they have been in the washer-disinfector?

A

illuminated magnifier

31
Q

give 5 reasons as to why steam is used in sterilisation

A
  1. carries a massive amount of energy
  2. non-toxic
  3. for certain applications, it can be recondensed and used agin
  4. water is readily available
  5. no waste product except water
32
Q

what type of water must be used for the production of steam for sterilisation processes?

A

purified water
(RO, de-ionised, distilled, sterile)

33
Q

why is steam used rather than water to sterilise?

A

the volume of steam in comparison to the water used to generate it is in excess of a thousand times greater
creates a huge amount of pressure within small confined spaces

34
Q

name 3 types of steriliser available within the dental environment

A

type N
type B
type S

35
Q

desribe the type N steriliser

A

most basic process of the sterilisers
aka gravity displacement steriliser/autoclave

36
Q

describe the type B steriliser

A

most robuse processing cycle
aka vacuum capable/porous load steriliser

37
Q

how does the type N steriliser work?

A

heats water in the chamber
passively forces the steam from the the chamber

38
Q

what are the disadvantages of the type N steriliser?

A

process isn’t entirely efficient- pockets of air can be left in the chamber
cannot process wrapped/channeled/lumened instruments

39
Q

why is having pockets of air in a steriliser an issue?

A

air cannot be heated or maintain temperature the same way as steam- it is always at a lower temperature than the steam surrounding it
any instruments in contact with air rather than steam may not reach their sterilisation temperature for the time required

40
Q

what temperature do the type N and B sterilisers operate at and what is the corresponding pressure?

A

134-137C
2.05-2.35 bar gauge

41
Q

what is the first step of the type B steriliser?

A

remove all of the air from the chamber, creating a vacuum (negative pressure)

42
Q

name 5 common daily tasks required to be carried out on the sterilising machines

A
  1. checking door seals are intact and free from debris
  2. verify the chamber is free from damage, debris, contamination or instruments from previous cycles
  3. verify the condition og the load carrier
  4. fill and drain the feedwater reservoir each day
  5. drain the used water reservoir each day
43
Q

what specific tests must be carried out on the type B steriliser?

A

daily- steam penetration test with bowie dick test
weekly- air leakage test and air detector function test

44
Q

what are the requirements of the container used to transport contaminated instrumentation?

A
  • rigid sided
  • tight fitting lid
  • leak proof
  • colour coded or clearly marked
45
Q

what are the uses of a li magnifier?

A
  • identify any damage present on the instrumentation
  • identify any spots of residual contamination
46
Q

what does the sinner circle show?

A

4 key elements that are required for a successful cleaning process
1. energy
2. chemicals
3. temperature
4. time

47
Q

discuss the use of detergents and disinfectants in the decontamination of dental instrumentation

A
  • high/low alkaline detergents- enclosed processes
  • ezymatic detergent- breaks protein down into smaller particles (used in ultrasonic and manual)
  • pH neutral detergent for manual and WD
48
Q

why is it important that instruments are sterilsed?

A
  • reduces probability of infection transmission
  • international standard for surgical standards
  • legislative and professional standards
  • maintaining high quality of care for patients
49
Q

name some of the initiatives that have been put into place to help implement changes in decontamination procedures within the NHS

A
  • teaching in undergraduate dental programme
  • teaching in dental nurse training
  • online training to update current NHS staff
  • NHS education scotland has an infection control dental support team that visits practices
50
Q

define ‘decontamination’

A

the process by which reusable items are rendered safe for further use on paitnets for staff to handle

51
Q

why is disinfection carried out after cleaning?

A

reduces the number of viable microorganisms on the instruments, making them safer to handle

52
Q

name 5 factors which contribute to effective decontamination

A
  • facilities for decontamination that are fit for purpose and well organised
  • suitable equipment that is validated and undergoes periodic testing and maintenance to ensure it is functioning correctly
  • establishment of a standardised decontamination process that is followed
  • management of the process with suitable documentation
  • staff who are suitably trained in all decontamiation procedures used in the practice
53
Q

what is the aim of MDDP?

A

managing decontamination in dental practice
aims to help practices create the documentation that underpins a decontamination management system by supplementing the documents that the practice already has

54
Q

what is the difference between a practice and a policy?

A

policy- states what the practice sets out to do
procedure- a more detailed guide for what to do to put the policy in place

55
Q

what should you do if the MI on a certain instrument state that it cannot be decontaminated with the equipment available in your practice?

A

buy single use instruments

56
Q

name 4 main points that staff should be taught in the basics of infection control

A
  • how infections are transmitted
  • how to prevent transmission of infections
  • what to do in the event of an accident or personal injury
  • your practice policy on infection control
57
Q

what does LDU stand for?

A

local decontamination unit

58
Q

what items should be arranged on an easily cleaned worktop in a single rpp, LDU? (order important)

A
  1. a separate hand washing facility with PPE storage
  2. a setting down area for dirty instruments
  3. a washing sink with detergent for cleaning instruments
  4. a setting down area for washed instruments
  5. an ultrasonic cleaner, if appropriate
  6. a rinsing sink
  7. a setting down srea for rinsed instruments
  8. an automated washer disinfector
  9. a setting down area with task lighting and magnifier for inspection of all instrumetns and, if appropriate a dental handpiece lubricator
  10. an area for wrapping instruments
  11. a steam steriliser
  12. an area for setting down and wrapping instruments sterilised in a non-vacuum steriliser
59
Q

where should instruments be stored prior to use?

A

in a clean, orderly enclosed storage area
not open shelving
ideally located in an area separate from the LDU

60
Q

why should portable fans not be present in an LDU?

A

rapid uncontrolled air circlation can spread contamination

61
Q

define validation

A

the means by which an entire process is dicumented, tested and able to be repeated

62
Q

what is an automatic control test?

A

test enuring that the WD continues to function correctly and involves checking readings and timings during a normal cycle

63
Q

describe how an automatic control test is carried out

A
  • place a normal standard load in the chamber of the WD
  • select the operatinf cycle to be tested
  • start the cycle
  • check the printout or data logger to ensure tha the required parameters have been met
64
Q

when is an automatic control test considered successful?

A
  • visual display ‘cycle complete’ appears
  • the variables indicated on the WD are within the limits established as satisfactory
  • during disinfection hold period, temp and time are within range specified
  • the person conducting the test doesn’t observe any mechanical or other anomaly
65
Q

what is a cleaning efficacy test?

A

used to demonstrate the ability of the WD to remove soiling and contamination

66
Q

name 3 forms of efficacy testing

A
  1. visual inspection
  2. residual protein detection- involves a test for residual protein on instruments
  3. chemical test- involves removal of artificial soil from a test device designed for use in WDs
67
Q

why are instrumentation classed as ‘sterilsed’ and not ‘sterile’ after a type N cycle?

A

the instrument does not remain sterile beyond the end of the sterilisation

68
Q

how should instruments be loaded into the steriliser?

A
  • load according to the MI and as specified at validation
  • ensure instruments don’t overlap
  • open hinged instrumetns
  • place instruments to expose all of the surface area to the steam
  • plase instruments on perforated trays, cassettes or racks that have been validated for use with teh selected sterilisation cycle
  • don’t overload the sterilser chmaber or indivdual trays or containers with instruments

patient safety (2 decks)

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