Infection Prevention And Control And Decontaminaton

Question 1

Why is prevention and control of infection important?

Answer 1

To prevent the transfer of microorganisms from the patient to dental team, dental team to patient, patient to patient, dental surgery to community, community to patient

Question 2

Different microorganisms that can be found?

Answer 2

Bacteria, viruses, fungi, parasites, prions

Question 3

Stages of infection

Answer 3

Prodromal stage: feels normal, slightly off colour. Before overt signs.
Overt infection: signs there is something not right
Chronic infection: carrier status and can be infectious to others

Question 4

Mode of transmission of microorganisms

Answer 4

Direct contact, indirect contact (touching fomites), indirect contact by inoculation by contaminated objects, droplet infection, airborne infection by aerosol infection.

Question 5

What are aerosols?

Answer 5

Particles < 5micrometers

Question 6

How long can aerosols remain airborne for?

Answer 6

Hours/days

Question 7

How are aerosols generated?

Answer 7

Air-rotor/cavitron aerosol

Question 8

Mode of entry of microorganisms

Answer 8

Mucous membranes, ingestion, inhalation, breaks in the skin

Question 9

What is done to stop infection?

Answer 9

Standard infection control precautions (SICPs)

Question 10

Additional precautions to SICPs

Answer 10

Transmission based precautions (TBP). These prevent infections that spread:

• via direct contact with patient or indirectly from patients immediate care environment
• via droplets spread over short distances (at least 1metre) via droplets from the respiratory tract of individuals directly onto mucosal surface of another individual
• via airborne aerosols from the respiratory tract of one individual directly onto a mucosal surface of another individual

Question 11

Why do we treat everyone as infectious?

Answer 11

Cos some will know and tell you, some won’t know and some will know and won’t tell you.

Question 12

Must Do’s of infection control

Answer 12

Hand hygiene, uniform and PPEA, disinfectants/antiseptics, equipment, water quality, decontamination, waste disposal, sharps handling and disposal, sharps injury

Question 13

What does nosocomial infection mean

Answer 13

That the infection has been acquired in a healthcare setting

Question 14

Hand hygiene

Answer 14

Bare below elbows
Gloves are only as clean as the hand inside
Short nails and no nail varnish
Wedding band only and must wash beneath
Kara must be taped high up arm

Question 15

Effective hand decontamination

Answer 15

Soap at start and end of duty for visible dirt on hands and if there is a norovirus outbreak
Alcohol for visibly clean hands 20 second rub, never on gloves and use soap if sticky residue
Surgical scrub for surgical work

Question 16

The time for right hand hygiene

Answer 16

Before patient contact
Before an aseptic procedure
After body fluid exposure work
After patient contact
After contact with patient surrounding

Question 17

Uniform and dress code

Answer 17

Hair tied back and contained
Religious headwear changed daily
Footwear must protect the foot and be safe to wear and be wipeable
Scrubs are uniform and protected with PPE, changed daily
ID badge for clinical duties - clip badge
PPE - mask, gloves, goggles, visa, apron/sleeves

Question 18

What potential sources of microorganisms are found in aerosols?

Answer 18

Saliva, blood, crevicular fluid, exhaled lung products, alimentary canal products

Question 19

How are aerosols tried to be reduced in splatter or splash?

Answer 19

Pre-procedural rinse of 1 minute of hydrogen peroxide mouth-rinse.

Question 20

What are aerosol generating procedures AGPs?

Answer 20

Mechanically create and disperse aerosols by air rotor handpieces. Make the patient gag/cough.

Question 21

What are aerosol generating exposures AGEs?

Answer 21

How long you are exposed to the aerosol. The AGP is reduced by mitigating factors, e.g. rubber dam, high volume suction.

Question 22

PPE for non AGPs

Answer 22

Apron (single use)
Fluid resistant surgical face mask type IIR
Gloves
Visor/goggles

Question 23

PPE for AGPs

Answer 23

Gown (single use)
Filter face piece (FFP3) respirator mask
Gloves
Visor
Theatre hat

Question 24

What is donning and doffing

Answer 24

Donning is putting PPE on and doffing it taking PPE off

Question 25

Order of removal of protective equipment

Answer 25

Gloves, gown, goggles, mask, wash hands

Question 26

When should clinical unit surfaces be wiped?

Answer 26

Clear unit at start of session, between patients and end of session. Dual action wipes Detergent and disinfectant combined in the wipe

Question 27

When should gloves be removed?

Answer 27

When touching common equipment materials and non-clinical activity like typing notes and using phones.

Question 28

What happens if the waterlines are not clean?

Answer 28

Biofilm will be produced

Question 29

Water flushing protocol

Answer 29

4 mins Monday AM, 2 mins tues-fri AM 2 min at start of AM and PM session 20 seconds between patients 2 minutes at end of day

Question 30

Decontamination cycle

Answer 30

Disinfection, inspection, packaging, sterilisation, transport, storage, use, transport, cleaning etc

Question 31

Inspect instruments after use

Answer 31

All cement and dental materials must be removed from instruments before return to decontamination centre

Question 32

Disinfection of appliances for mouth

Answer 32

Disinfect before and after lab by 1 min in 10% hypochlorite and rinse under water. For sending to lab ensure thoroughly dry before placed in plastic bag.

Question 33

Sharps handling and disposal

Answer 33

``` Sharps disposal (yellow bin yellow lid) Pharmaceutical waste (yellow bin blue lid) ```

Question 34

Disposal of waste

Answer 34

Clinical waste separate to domestic waste | Extracted teeth containing amalgam separate

Question 35

Sharps handling

Answer 35

Always stay behind the needle Ensure safety feature activated every time Double-click lock before disposal Hold cartridge end for disposal Remove burs/files/tips from hand piece when not in use (common inoculation injury) Ensure sharps instruments are seated horizontally in the tray Use mirror for injections for tissue retraction Never pass or receive an unsheathed needle Never bend the needle Operator removes and disposes of sharps Ensure sharps bins are close during venepuncture Never fill sharps container above black line Operator should hold sponge ring holds and gauze and wipe

Question 36

Inoculation injuries sero-conversion risk

Answer 36

``` Hepatitis B (1 in 3) Hepatitis C (1 in 30) HIV (1 in 300) ```

Question 37

What to do in the case of an inoculation injury

Answer 37

- stop and encourage wound to bleed under running water - wash with soap - tell another clinician on the department that they have had an inoculation injury (deal with managing process) - managing clinician will tell patient what has happened and ask they have a blood test - source patient and recipient of injury have blood taken - telephone occupational health and give full details of injury - complete a Datix form - student checklist form for school office