dn12 Flashcards

Question

CHRONIC INFLAMMTION?

Answer 1

when the swelling is less pronouced and occurs over a long period of time and it tends to be far less painful or even painless compared to acute inflammation. (dental example is CHRONIC PERIODONTITIS)

Answer 2

a VIRAL INFECTION that destroys the body's LEUCOCYTES, weakning the patients immune system and leaving them unable to fight off diseases naturally. they eventually go on to develop AIDS, a fatal condition and for which there is no vaccine currently available.

Answer 3

a VIRAL INFECTION affecting the lips and oral cavity in particular. it is not fatal, but is highly contagioua when 'COLD SORE' lesions are present on the lips of the sufferer

Answer 4

main modes of transmission of HBV are CHILDBIRTH, the SHARING OF NEEDLES by drug addicts, and SEXUAL CONTACT. certain groups include: - drug addicts - the sexually promiscuous - haemophiliacs, dialysis and transplant patients - special needs patients living in institutions, and staff in close contact with them - those working or living in institutions, such as prisons or rehabilitation centres for drug addicts and alcoholics - partners and close relatives of carriers, not necessarily with sexual contact

Answer 5

the basic principle of preventing infection with HBV is to avoid contact with the patient's blood. extra precautions have been recommended for general practice: - for operations involving extensive loss of blood, such as multiple extractions and minor oral surgery, refer the patient to hospital - reserve the last appointment of the day for treatment of know carriers - move all unnecessary equipment and materials away from the chairside - take great care to avoid inoculation injuries - regard steel burs and matrix bands as disposable. after treatment flush the aspirator tubing through with hypochlorite and leave solution in a collection jar overnight.

Answer 6

those most at risk of being carriers are: - the sexually promiscuous - drug addicts - haemophiliacs and other patients who have recieved long-term blood transfusions - sexual partners of these groups - infants born to infected mothers

Answer 7

- for operations involving extensive loss of blood, such as multiple extractions and minor oral surgery, refer the patient to hospital - reserve the last appointment of the day for treatment of know carriers - move all unnecessary equipment and materials away from the chairside - take great care to avoid inoculation injuries - regard steel burs and matrix bands as disposable. after treatment flush the aspirator tubing through with hypochlorite and leave solution in a collection jar overnight.

Answer 8

this is one of a group of RARE, but FATAL, related diseases caused by infection with a unique non-microbial source of disease called a PRION PROTEIN. this infection occurs within nerve tissue, affecting both the brain and all nerve tissues throughout the body.

Answer 9

- stop all treatment immediately and attend to the wound - squeeze the wound to encourage bleeding, but do not suck it - wash the area with soap and running water, then dry and cover the wound with a waterproof dressing - note the name, address and contact details of the source patient if a contaminated item is involved, so that their medical history can be checked immediately - complete the accident book - report the incident to the senior dentist/line manager - the consultant microbiologist at the local hospital must be contacted immediately if the source patient is a known or suspected HIV or hepatitis C carrier, as emergency antiviral treatment must commence within 1 hour of the injury

Answer 10

- correct cleaning of hands - use of PPE - correct cleaning of the clinical environment - correct cleaning of dental equipment, handpieces and instruments

Answer 11

clean to a socially acceptable standard, but not disinfected or sterilised

Answer 12

the destruction of bacteria and fungi, but not spores or some viruses

Answer 13

the process of killing all microorganisms and spores to produce asepsis

Answer 14

the absence of all living pathogenic microorganisms

Answer 15

``` the process used to remove contamination from reusable items, so that they are safe for further use on patients and safe for staff to handle. this involves the following four stages: - CLEANING - DISINFECTION - INSPECTION - STERILISATION ```

Answer 16

SOCIAL - to become physically clean from socially acquired microorganisms, using general-purpose liquid soap CLINICAL/HYGIENIC - to destroy microorganisms, maintain cleanliness and avoid direct cross infection using an approved antibacterial hand cleanser SURGICAL - to significantly reduce the numbers of normally resident microorganisms on the hands, before an invasive surgical procedure is carried out, using an approved antibacterial hand cleanser

Answer 17

- gloves of varying quality, - high-temperature-wash uniform, to be worn in the work area only - plastic apron to be worn over the uniform when soiling may occur during surgical procedures - safety glasses, goggles or visors to protect

Answer 18

in clinical areas, a far higher standard of cleaning is necessary becuase these are the areas where contamination of the environment by the body fluid is greatest and where the highest chance of cross-infection is likely to occur.

Answer 19

this involves the use of various chemicals to inhibit the growth of, or ideally kill, bacteria and fungi. howerver most are not effective against bacterial spores or some viruses. those in common use in the dental workplace include the following: - BLEACH-BASED CLEANERS - containing sodium hypochlorite and used to disinfect all non-meatalic and non-textile surfaces, and to soak laboratory items - ALDEHYDE-BASED CLEANERS - can be used on metallic surfaces and to soak laboratory items - ISOPROPYL ALCOHOL WIPES - to disinfect items such as exposed X-ray film packets for safe handling during processing - VIRCIDAL WIPES -as a recommended alternative to alcohol wipes, as they actually kill viruses - CHLORHEXIDINE GLUCONATE - as an irrigating disinfectant during root canal tretments and as a skin cleanser

Answer 20

the risk of cross-infection between patients can be eliminated by the use of DISPOSABLE ITEMS that are safely discarded after a single use, rather than being cleaned and reused. for expensive items, such as handpieces and metal hand instruments, this is not feasible and so these items must be DECONTAMINATED and then STERILISED to ensure that all microorganisms and bacterial spores have been killed during the cleaning process. any single-use items that are to be disposed of are classed as HAZARDOUS WASTE and treated accordingly. other items are as follows: - all items which are not disposable after a single use should be sterilised in an autoclave - before placing in an autoclave, all solid debris must be removed from the items, either by manual cleaning, the use of an ULTRASONIC BATH or the use of a WASHER-DISINFECTOR - only then should these items be autoclaved, as any residual solid debris left on the items will harbour microorganisms and spores, and shield them from the sterilisation process so that they are capable of causinf cross-infection - handpieces must not be placed in an ultrasonic bath, and the manafacturer's specific instructions should be consulted with regard to their advice on oiling after sterilisation - sterilised instruments should be stored in lidded trays in cupboards or drawers, or in sealed and dare-stamped pouches until they are next used, or until they pass the "use by" date and re-sterilised

Answer 21

The basic procedure for safe and effective manual cleaning of items is as follows: - wear suitable PPE - always clean the items as soon as possible after use, to avoid contaminants drying onto their surfaces - - use cold water and a suitable detergent in a dedicate instrument-cleaning sink/bowl - use nylon bristled, autoclaveable scrubbing brushes to remove difficult contaminants, as wire bristles will scratch the metal surfaces and allow corrosion and rusting to occur - the items should be scrubbed while under the water surface to avoid spraying contaminants into the immediate vicinity - a seperate sink/bowl of distilled or reverse osmosis water should be used to rinse the items after cleaning, in order to remove any detergent and loose contamination - tap water must not be used as it will contain unwanted chemicals and its level of "cleanliness" is dependent on the water utility provider rather than on the workplace - the items should be visibly inspected to ensure that all containation has been removed. - the items should then be autoclaved as soon as possible before they can dry in the air - this can result in corrosion or recontamination otherwise - those that are to be bagged before vacuum sterilising should be dried thoroughly first

Answer 22

these are suitable devices that act to remove debris from items by vibrating at an ultrasonic-frequency and transmitting that vibration to the instruments loaded into the bath on the tray. they require the use of special detergents diluted in distilled/revers osmosis water with the bath to be effective, and the solutuion should be replaced at the end of each clinical session or when it is obviously heavily contaminated with particles of debris

Answer 23

- heavy soiling with blood and other visible contaminants should be reduced by briefly soaking the items in cold detergent solution beforehand and then rinsing - hinged items (such as extraction forceps) should be opened and assembled items (such as amalgam carriers) should be disassembled - all items should be placed on the bath tray and be fully immersed beneath the solution, to allow debridement to occur effectively - the bath should not be overloaded with items, as debridement will not be effectively - the timer should be set according to the manafacturers's instructions, the lid closed on the machine and the programme started - the lid must be closed to prevent aerosol contamination of the vicinity - when the timer ends, the basket and its contents should be lifted and allowed to drain; the items should then be rinsed in a dedicated sink/bowl of distilled or reverse osmosis water - the items should be visibly inspected to ensure debridement has occured and, if debris remains, put through the process again - items should be sterilised as soon as possible after being decontaminated, as for manually cleaned items

Answer 24

Daily duties are as follows: - STRAINER/FILTER CLEANING - remove these items from the bath and clean using a suitable detergent solution and brush, to remove the debris contamination produced during normal operation - TANK DRAINING - the bath solution should be fully drained at the end of the day, or at the end of a busy clinical session, so that contaminants are disposed of rather than transferred to future instruments - CLEANING CHECK - all instruments placed in the bath should be visibly checked at the end of the cycle to ensure that all visible debris has been removed - an illuminated magnifier should be availible for use during this procedure Weekly duties are as follows: SAFETY CHECK - ensure that the lid of the bath fits adequatley and continues to prevent aerosol contamination of the surrounding during use. check for signs of any solution splatter around the unit PROTEIN RESIDUE TEST - use of a special test device to ensure that protein residues are being removed effectively during the ultrasonic cycle, so that items are indeed decontaminated before sterilisation Another test that can be held on a quarterly-basis tot est the efficiency of the debridement action of the ultrasonic bath is an ACTIVITY TEST USING ALUMINIUM FOIL. it invloves immersing several strips of aluminium foil in the bath solution and running a normal cycle, on inspection, the aluminium should be eroded off the strips at similar points along their length, indicating that the debridement action occurs similarly throughout the whole tank

Answer 25

this machine goes through five stages during the cleaning and disinfection process, as follows: - FLUSH - an initial pressure rinse to remove gross solid and liquid debris from items; previously this was using water at high temperatures, but now a temperature below 45C is recommended to prevent the possibilty of protein fixing and the consequent failure of the disinfection cycle - WASH - use of recommended detergent and/or disinfectant with watr to complete the removal liquid and solid debris, by both chemical and mechanical actions during the wash process - RINSE - using suitable quality mains water or reverse osmosis water to remove all traces of the detergent/disinfectant solution; any evidence of marking, smearing or spotting on the cleaned items indicates that the water quality is inadequate for use in the machine - THERMAL DISINFECTION - the tempreture used is pre-set at the start of the cycle and can be varied depending on the contents of the load to be disinfected; the chosen tempreture is then achieved and held for the required time within the machine - DRYING - heated air is pumped into the disinfection chamber so that any residual moisture is removed from all the items before the end of the cycle, as wet items will allow microorganisms to recolonise their surface more readily.

Answer 26

AUTOMATIC CONTROL TEST - to ensure that the cycle parameters set are actually achieved, with regard to temperature, time, drying etc. CHEMICAL DOSING - test to ensure that the detergent and/or disinfectant is released into the machine correctly during the cycle and that low levels of either are indicated as necessary THERMOMETRIC DISINFECTION TEST - using a heavily soiled load, the temperatures achieved during the cycle are tested to ensure that those reached are suitable to ensure disinfection has occurred,

Answer 27

- heats to 134C and holds for 3 minutes at 2.25 bar pressure - steam displaces air downward in the chamber so that it contact all item - the cycle last for 15-20 minutes, depending on the make of the autoclave and how often it has been in use perviously, as it warms up and retains the heat after each use - it is suitable for unwrapped solid items laid in a single layer on perforated trays - the machine can hold several trays a time, cutting the number of cycles required - the cycle can be set to dry instruments before they are removed from the autoclave - the door cannot be opened during the operation until the cycle is completed

Answer 28

- heats to 134C and holds for 3 minutes at a 2.25 bar pressure - air is sucked out of the chamber to create a vacuum so that steam contact all the items pre-sent as it also sucked through, including the insides of hollow items - there are various cycles to choose from, depending on the requirements of the loaded items for each cycle - the cycle can last for up to 45 minutes if a vacuum programme is required - the vacuum cycle is suitable for wrapped items and those with a hollow lumen, such as handpieces and triple syring tips - the machine often has a dat-logging device incorporated so that the operating parameters for each cycle are recorded and can be checked - the machine can hold trays at a time, cutting the number of cycles required - the cycle can be set to dry instruments before they are removed from the autoclave - the door cannot be opened during the operation until the cycle is completed - it is more expensive than the 'N' type autoclave

Answer 29

the correct handling and storage of items once they leave the autoclave is imperative in ensuring that their sterility is mainteined until they are required for use again. the obvious ays of achieving this as follows: - removing them from the autoclave and handling while wearing clean PPE - drying them with a single-use cloth or towel - placing within a device to act as a barrier between the items and the general atmosphere to avoid aerosol and microorganism recontamination, such as: - sealed view pouch - lidded tray - sterilisation bag

Answer 30

- daily test carried out on each autoclave, recording the temperature, pressure and time interval for a full cycle - these dtails must be kept as a written record in a dated log book - an automatic control test should be carried out daily for all types of autoclaves, and the test strip retained within the workplace records - the usual technique is to use a 'TST' strip or something similar - a stream penetration test should also be carried out for vacuum autoclaves to ensure that these are usually performed using a helix or bowie-dick test - only purified reverse osmosis water should be used within the autoclave, never tap water - water should be drained from the reservoir and replaced daily - door seal and safety devices usd to prevent door opening during the cycle must be visually checked on a weekly basis by designated staff - an authorised engineer must carry out an anual inspection to ensure that each autoclave operates correctly and issue a certificate to that effect - each autoclave must also be checked for its conformation with the pressure systems safety regulations on a regular basis - the practice's insurance policy must include third party liability cover for the use of autoclaves, in case of explosion and resulting injury to staff or patients - any serious accident involving an autoclave, including its explosion, must be reported ti the health and safety executive (HSE) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulation (RIDDOR)

Answer 31

some single-use products are provided by manufacturers as pre-packaged sterile items, such as syringes and needles, local anaesthetic cartridges, scalpel blades, swabs and other cotton products, gutta-percha and paper points used in endodontic treatments, and more recently the endodontic hand instruments themselves. these are industrially sterilised within sealed packages after production, by exposure to gamma rays, a type of radiation similar to X-rays. as gamma radiation is higly dangerous, it must be used under strict regulation and in specialised control zones, so it is not suitable for use in dental practice.

Answer 32

- the decontamination room must be seperated physically from all clinical areas - ideally, the dirty zone, where the items are recieved for reprocessing, and the clean zone, where the sterilised items are produced, should be seperated rooms - this allows for maximum possible seperation of dirty and clean items, and therefore the minimum possibility of recontamination - there should be a flow of air from the clean and dirty in the decontamination room(s) - a single worktop are should run the length if the room, and be long enough to allow the autoclave to be well away from the cleaning decontamination area - the worktop should be sealed along its length and its surface should be easily cleanable - the dirty and clean zones should be clearly labbeled as such, to avoid cross-contamination between them

Answer 33

the current classification of waste produced in the dental workplace is divided into four main areas - - non hazardous waste - offensive waste - trade waste - hazardous waste

Answer 34

includes medicines, out of date stock, and lead foil from x-ray packets

Answer 35

Sharps - includes teeth without amalgam, fillings present and used LA cartridges Soft - includes all PPE, dressings, swabs, surgery wipes, etc

Answer 36

processing fixer and developer, waste amalgam and mercury, teeth with amalgam fillings, amalgam capsules

Answer 37

- Health and Safety at Work Act - Care Quality Commission (CQC) - Department of Health guidelines on Decontamination in primary care dental practices - HTM 01-05 - Control of Substances Hazardous to Health (COSHH) - Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (RIDDOR) - Special Waste and Hazardous Waste regulations - Environmental Protection Act

Answer 38

the health and safety legislation seek to protect staff and encouraging them to find the best ways of their particular premises safer for all concerned. in legal terms, the employer has a statutory duty to ensure that, as far as is reasonably practicable, the health, safety and welfare at work of all emplyess and all visitors (including patients) is protected at all times the potential hazards to people's safety are the following: - cross-infection - inoculation injury - use of hazardous chemicals to control the spread of infection - use of dental equipment that may cause injury during malfunction as with all health and safety issues in the workplace, a full risk assessment of the potential hazards must be carried out to identify what is the risk, who is the risk, how they are at risk, how to reduce or elimanate that risk, and to record the risk assessment findings.

Answer 39

since the empowerment of the Health and Social Care Act of 2008, the CQC has been the organisation responsible for ensuring adequate standards in premises such as hospitals, nursing homes for the elderly, and care homes for those with a wide range of special needs. the stated aim of CQC is to "make sure that people get better care". they achieve this by: - driving improvement across health and adult social care - putting people first and championing their rights - acting swiftly to remedy bad practice - gathering and using knowledge and expertise, and working with others

Answer 40

In England, the guidelines applicable with regard to decontamination in general dental practice are covered by the department of health document HTM 01-05. this is produced as a guide to decontamination techniques for use in the dental workplace itself and is a "working document" in that it may be updated as evidence of better techniques ans systems become available. it is intended to help dental workplaces establish a programme of continous improvement in their decontamination techniques. those currently included are listed in two categories: ESSENTIAL QUALITY REQUIREMENTS - the basic level of decontamination standards that all workplaces will achieve within the first year of implementation of the guidance BEST PRACTICE - the "gold standard" to be aimed at in the future; the additional improvements required to achieve best practice cover the following main points: - use of a washer-disinfector to clean instruments - seperate facility for decontamination tasks, aways from the clinical treatment are - seperate storage are for sterilised items, away from the clinical treatment area

Answer 41

the determination of the level of risk from any of the chemicals or substances involved, those who may be harmed and the necessary precautions to take are all determined by carrying out a risk assessment. the process to be followed in this case is determined by the COSHH regulations, which require all dental workplaces to carry out risk assessments of all chemicals and potenially hazardous substances used in the premises, to identify those that could harm or injure staff members. the risk assessment process follows the usual steps, but the written report produced must include every potential chemical hazard found and the following specific information: - the hazardous ingredient(s) it contains - the nature of the risk, ideally by indicating the risk category using recognised symbols - the possible health effects of the hazardous ingredient(s) - the precautions required for the safe handling of the product - any additional hazard control methods required for its safe use - all necessary first aid measures required in the event of an accident involving the product

Answer 42

- IDENTIFY THOSE SUBSTANCES THAT ARE HAZARDOUS - by reading the manafacturers' leaflets and instruction sheets enclosed with the product, or shown on the label - IDENTIFY WHO MAY BE HARMED - this is likely to be anyone who uses the substance, although public access must also be taken into consideration - IDENTIFY HOW THEY MAY BE HARMED - e.g. is the product hazrdous on skin contact, or by inhaling fumes, or an eye irritant? - EVALUATE THE RISK - is the substance only harmful if misused, or is it harmful with every use? - DETERMINE WHETHER HEALTH MONITORING IS REQUIRED - e.g. during exposure to mercury, or nitrous oxide gas used in inhalation sedation as a conscious sedation technique - CONTROL THE RISK - by ensuring the substance is not misused; by providing suitable PPE, or reduce the risk as far as possible if it is harmful with every use; this may involve changing the product if the potential risk is considered too great - INFORM ALL STAFF OF THE RISK - through staff meeting and introduction of the COSHH sheets to be read and signed by all team members - RECORD THE RISK ASSESSMENT - keep documented evidence that the assessment has been carried out, with review and update dates recorded as necessary

Answer 43

bleach is a powerful disinfectant and is used in many situations in the workplace: - Fresh solution of 10000ppm (approx. 1%) to disinfect all non-metallic, non fabric surfaces within the surgery - Fresh solution of 10000ppm (approx. 1%) to disinfect impressions and removable prostheses before transferring between the patient and the laboratory - Fresh solution of 10000ppm (approx. 1%) to clean away blood spillages within the practice

Answer 44

accidents that occur in the workplace fall into one of the two categories: - MINOR ACCIDENTS - these result in no serious injury to persons or the premises and are dealt with "in house" and recorded in the accident book - a written record of the minor accident must be made and kept by the workplace in the accident book, under the Notification of Accidents and Dangerous Occurences Regulations - examples of minor accidents include a trip or fall resulting in no serious injury, a clean needlestick injury, or a minor mercury spillage that can be safely dealt with using the spillage kit - MAJOR ACCIDENTS - these result in a serious injury to a person or severe damage to the premises - they are classed as "significant events" and are therefore notifiable incidents that must be reported to the HSE under RIDDOR

Answer 45

- fracture of the skull, spine, or pelvis - fracture of the long bone of an arm or leg - amputation of a hand or foot - loss of sight in one eye - hypoxia (oxygen deprivation to the brain) severe enough to produce unconsciousness - any other injury requiring twenty four hour hospital admission for treatment

Answer 46

the diseases that must be reported under RIDDOR are any that cause acute ill health by infection with dangerous pathogens or infectious materials, such as: - LEGIONELLA - causing legionnaires' disease - HEPATITIS B OR HEPATITIS C INFECTION - both linked to the development of liver cancer - HIV - causing AIDS

Answer 47

the dangerous occurrences that must be reported under RIDDOR are as follows: - explosion, collapse or burst of a pressure vessel (an autoclave or compressor) - electrical short circuit or overload that causes more than a 24-hour stoppage of business - explosion or fire due to gases or inflammable products that causes more than a 24-hour stoppage of business - uncontrolled release or escape of mercury vapour due to a major mercury spillage - any accident involving the inhalation, ingestion or absorption of a hazardous substance that results in hypoxia severe enough to require medical treatment

Answer 48

the relevent category of waste is that reffered to as "infectious hazardous waste" and includes any item that may cause cross-infection if not handled safely. it includes all of the following: SOFT WASTE - all items of used PPE, tissues, paper towels, rinsing cups, used X-ray film packets, used plastic barrier shield, any other non-sharp waste that may be contaminated by body fluids by use on a patient. SHARPS WASTE - needles, blades, matrix bands, burs, teeth without amalgam fillings present, local anaesthetic cartridges, any other sharp items that may cause injury if mishandled

Answer 49

in accordance with the environmental protection act, the duty of care is with the dental workplace to ensure that the healthcare waste is managed and disposed of safely and correctly. to comply fully, all dental workplaces must ensure that they: - have a written healthcare waste policy in place which identifies a named person as responsible for waste management on the premises - provide staff access to the policy and give recorded training in correct waste management methods - segregate waste and store it safely while on premises, away from public areas - use the correct storage containers for each waste category - only used licensed waste collectors for the removal from the premises and disposal of the waste at an authorized disposal site - accurately describe the container contents of all non-hazardous waste on transfer notes, which must be kept for a minimum of 2 years from the date of the collection -accurately describe the container contents of all hazardous waste on consignment notes, which must be kept for a minimum of 3 years from the date of the collection - recieve and keep quarterly "consignee returns" documentation which records the final destination of the hazardous waste consignment and its disposal details - register with the environment agency as a hazardous waste producer if more than 500kg of hazardous waste is produced anually SOFT INFECTIOUS HAZARDOUS WASTE - orange sack, no more than three-quarters full and tied at the neck SHARPS INFECTIOUS HAZARDOUS WASTE - all yellow rigid container, no more than two-thirds full

dn12 Flashcards

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